PRIA Healthcare Management, LLC offers a rewarding environment for self-motivated, performance driven individuals. Headquartered in the United States, we are a full-spectrum reimbursement services organization that partners with clients from early ideation through commercialization. Our team’s mission is to accelerate the adoption of healthcare innovation by advocating for consistent and reliable reimbursement. PRIA is comprised of experts from reimbursement/ market access, industry, business, and finance.

We are currently looking for a full-time, remote (or hybrid if local to CT) Patient Access Specialist that is ready to join our team of skilled and dedicated individuals supporting the mission of patient access to care and customer service. We prioritize employee growth by providing a clear progression pathway through various levels of roles, beginning with our most entry-level role as Junior Patient Access Specialist up through Executive Patient Access Specialist, individuals can develop their skills and expertise, leading to opportunities for advancement into more senior roles.

Position Overview:
The Patient Access Specialist is responsible for supporting our client’s reimbursement needs to facilitate patient access to their technologies and procedures. This position will support a variety of key economic stakeholders including client company representatives and their customers including physicians, billing and coding personnel, hospitals, and ambulatory surgical centers. This position will be accountable to serve as a resource in patient access services including, benefits verification, prior authorization, pre-service appeals and post service claims appeals.

Key Responsibilities:

Manage a case load for an assigned program
- Data entry and review of new patient cases into system database
- Communicate with physician’s office and their staff regularly
- Maintain accurate and up-to-date records within the Salesforce platform to ensure accurate reporting to clients
- Complete full patient access process as outlined by program SOP including but not limited to:
  - With Assistance from the Executive Lead, Analyze and interpret patient clinical data, clinical notes and files to determine medical necessity criteria is met specific to each payer policy
  - With assistance from the Executive Lead, Review multiple insurance policies to define medical necessity criteria to support medical device/procedure(s)
  - Benefits verification and payer discovery
  - Prior Authorization/ Pre- service review submissions, pre and post-service appeal submissions
  - Ensure all documents developed to support an appeal are accurate, consistent, up to date, and in compliance with applicable Standard Operating Procedures, guidelines, and regulations
- Ensure compliance with all regulatory and company policies

KPI's:

Established based on the program complexity and align with program success
- Once KPIs are established they are measured daily, weekly and monthly

Qualifications:

High school diploma or equivalent; Associate’s degree preferred.
Minimum of 2 years of experience in a healthcare setting, preferably in authorization or billing.
Understanding of medical terminology and insurance processes.
Excellent communication and organizational skills.
Ability to work independently and handle multiple tasks.

Benefits:

Competitive compensation package
Generous Paid Time Off
Comprehensive Medical/Dental/Vision plan
401K with 3% match
Tuition Reimbursement Program
Generous Employee Referral Program
Rewards & Recognition Platform
Professional development opportunities
Employee health & wellness programs

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