Access Manager - Healthcare Claims, PAs, Reimbursement & Appeals

The Access Manager role supports our Patient Services programs by strategically navigating the patient access process from start to finish. This role is responsible for identifying and addressing barriers to care, from the initial benefit verification through treatment initiation and resolution of any claims or reimbursement issues, as requested. This position involves relationship management and education for physicians, their office staff, payors, patients, and clients on the support services and resources offered through the program. The role focuses on providing guidance and support to help overcome coverage, authorization, and reimbursement barriers, ensuring access to therapy. 

The Access Manager collaborates closely with the FRM Team and other Patient Services functions, as needed, as well as with patients, providers, facility contacts, clients, and other internal and external stakeholders. This role ensures seamless coordination across all touchpoints, managing each case with highest level of accuracy, efficiency and completeness to support timely patient access to therapy.  

     

Core Duties/Responsibilities:  

• Manage end-to-end case activities throughout the insurance verification and authorization process to establish coverage approval, secure appropriate payment channels, and coordinate copay or foundation assistance, as needed. 
• Effectively manage and prioritize competing demands including insurance approval timelines, patient treatment schedules, and stakeholder communications, while supporting various clients, patients, customers and their products with accuracy and responsiveness
• Ability to serve as the single point of contact between the internal/external team, client, provider, payor, facility, and patient.
• Provide support across multiple client programs, ensuring effective oversight, operational excellence, and consistent delivery of quality service.

 

Skills / Requirements:

• Proficient in working through varying prior authorization and reimbursement scenarios.
• Skilled in verifying patient benefits, analyzing clinical documentation against payor/plan coverage policies and criteria to ensure accurate access determination. 
• Demonstrates comprehension of insurance verification, prior authorization, and appeals processes as they relate to coding, coverage, and payment.
• Maintains open and effective communication, ensuring clarity and thoroughness in all documentation, reporting, verbal and written correspondence.  
• Exhibits a high level of organizational and multitasking ability, effectively coordinating multiple priorities, projects, and activities to achieve goals and deliver results within established timelines.
• Ability to independently manage case load, prioritize work, and use time management skills to manage deliverables.
• Suggests creative ideas and innovative solutions while exploring multiple alternatives and approaches to overcome obstacles and find solutions.
• Operates with high degree of independence, showing consistent follow-through, determination, and resilience to overcome challenges and deliver results.
• Remains calm, focused, and productive during transitions and periods of change, maintaining stability and guiding and supporting others through shifting priorities. 
• Strong ability to independently identify and resolve problems, while recognizing when to seek input or collaboration to ensure best outcomes.
• Communicates effectively both verbally and in writing, demonstrating empathy, professionalism, and a strong commitment to customer satisfaction and exceptional service.
• Demonstrates agility in quickly learning and implementing new processes, systems and protocols to drive continuous improvement and operational excellence.

 

Education, Certifications and Experience:

• Advanced knowledge and experience in healthcare setting.
• Possess a strong understanding of biologic and specialty pharmaceutical markets, including reimbursement dynamics and patient access challenges across diverse payor landscapes.
• College degree (bachelor’s or associate degree) is preferred.
• 2 – 4 years of experience in a pharmacy, healthcare setting, and/or insurance background with a customer service focus.

 

Physical Requirements: 

• As a remote-forward organization, this position operates in a professional office environment and teleworking from the employee’s home address listed in their employment file.
• Prolonged periods of sitting at a desk and working on a computer. 
• Keyboarding 
• Speaking 
• Must be able to lift up to 15 pounds at times 
• Flexibility of working hours to support activities across Eastern Standard Time (EST) to Pacific Standard Time (PST) zones.

 

Our PRO-Spectus Culture Philosophy

At PRO-spectus we have created a culture that is supportive, dedicated, and teamwork driven.  We celebrate each other’s joys in personal life and professional accomplishments, promoting meaningful relationships and friendships. 

Our employees bring strength of mind and spirit to make the extraordinary happen every day.  With humility and compassion at our core, PRO-spectus is proud of our relentless focus towards the higher purpose of improving the lives of patients we support.

We recognize it takes a lot of people working together with a common goal to make spectacular happen, and we never forget that at the heart of our company are the people who make it work.

PRO-spectus is an Equal Opportunity / Affirmative Action employer. All qualified individuals will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, age, disability, protected veteran status, marital status or other protected status under federal, state or local laws.

At PRO-spectus, we are deeply committed to pay transparency and equity. The salary range for this position is $36.00 - $42.00 an hour, based on experience and qualifications, with the final offer reflecting skills and other job-related factors. Beyond competitive pay, we offer a comprehensive and generous benefits package designed to support your well-being and work-life balance. 

Our benefits include robust medical, dental, and vision plans; life insurance and disability coverage; and tax-advantaged savings accounts. We also provide an Employee Assistance Program, home office benefits, and unique perks like an Employee Ownership Program. With paid time off, holidays, bereavement leave, and a 401(k)-retirement plan with employer matching, PRO-spectus prioritizes your financial and personal security. Plus, you may be eligible for a performance-based bonus opportunity. 

Join PRO-spectus, where your career growth, well-being, and contributions truly matter!