Patient Therapy Access Specialist

Required Qualifications 

• High School Diploma / GED an equivalent combination of education and work experience 

• Minimum 3 years, In fast paced data entry and administrative role. 

• General knowledge of private insurance, Worker’s Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review.  
  Some experience in medical device or DME Billing a plus.  
  Proficient with Microsoft Office (Word & Excel specifically).  
  Some knowledge of current CPT codes and familiarity with ICD-10CM (diagnosis coding).  
  Ability to accurately meet required time frames/deadlines.  
  Ability to work as a team player and share workloads with other team members.  
  Excellent communication skills; verbal and written.  
  Previous experience in public speaking or presenting to small groups.  
  Attention to detail.  
  Ability to travel 5% of the time.  
  Excellent organization skills and ability to multi-task in a fast-paced environment. 

• Minimum 2 years, In a utilization (medical approval) environment or similar work experience. 

Preferred Qualifications 

• Associate’s Degree Preferred  

• Knowledge of private insurance, Worker’s Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review. 

• Experience in medical device or DME Billing a plus 

• Proficient with Microsoft Office (Word & Excel specifically) 

• Medical billing software experience a plus 

• Knowledge of current CPT codes and familiarity with ICD-10CM (diagnosis coding) 

• Knowledge of medical terminology  

• Ability to accurately meet required time frames/deadlines 

• Ability to work as a team player and share workloads with other team members 

• Excellent verbal and written communication skills 

• Ability to train/present concepts to others 

• Proficient in navigating and utilizing various insurance payor portals (e.g., Aetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield) 

• Efficiently submits and manages precertification and prior authorization requests 

• Understands payer-specific requirements and documentation standards 

• Tracks and follows up on pending authorizations to ensure timely approvals 

• Able to troubleshoot portal issues and escalate when necessary