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Patient Access Specialist
PRIA Healthcare
Administration
Posted on Aug 12, 2025
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 thorough documentation, requiring strong attention to detail to ensure compliance with policies and case management standards
- 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:
- Analyze and interpret patient clinical data, clinical notes and files to determine medical necessity criteria is met specific to each payer policy
- Review multiple insurance policies to define medical necessity criteria to support medical device/procedure(s)
- Benefits verification
- Prior Authoriation/ 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.
Qualifications:
- High school diploma or equivalent; Associate’s degree preferred.
- Minimum of 2 years of experience in a healthcare setting.
- Must have prior experience with Prior Authorizations and Appeals.
- Understanding of medical terminology and insurance processes.
- Demonstrates ability to manage detailed information with accuracy and consistency, ensuring high-quality case documentation and follow-through.
- Excellent communication and organizational skills.
- Ability to work independently and handle multiple tasks.
Compensation & Benefits
- Competitive compensation package
- Generous paid time off
- Comprehensive Medical/Dental/Vision plan
- 401K with 3% match
- Generous Employee Referral Program
- Rewards & Recognition Platform
- Professional development opportunities
- Employee health & wellness programs