From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

Job Title: Patient Access Consultant

POSITION SUMMARY:

Under the general supervision of the designated manager, the Patient Access Consultant is considered a master of our services including but not limited to reimbursement activities, claim submission, claim status, collection activity, appeals, patient assistance and copay assistance. On a day to day basis they may be in contact with various customers of our services including but not limited to patients, providers, caregivers, and client brand teams.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Master of all standard and advanced services and willing to perform them as needed for the good of our patients, including but not limited to: billing and coding support; claims assistance, tracking and submission; prior authorization assistance and tracking; coordination of benefits; benefit verification result calls; welcome calls and advanced alternate coverage research; appeals/denials; inbound phone queue/general program inquiries; determination for support programs (Copay, Medicaid, etc.); pharmacy triage and coordination; order processing for product orders; other follow-up activities (missing info, prior authorization, etc.); intakes and reports adverse events as directed; and non-clinical adherence services.
• Engages with manufacturer representatives around items like payer profiles, reimbursement trends, and issues with specific offices.
• Responsible for coordination of services with field reimbursement teams and sales representatives.
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Independently analyzes, reports, resolves, and communicates any reimbursement trends/delays (e.g. billing denials, claim denials, pricing errors, payments, etc.).
• Processes any necessary correspondence.
• Coordinates with internal and external service providers to ensure services are performed in accordance with program policy and within expected service level agreements (SLA).
• Provides support to internal associates.
• Handles initial customer escalations.
• Verifies transactions and processes comply with organizational and departmental policies and procedures; suggests changes and solutions as appropriate.
• Independently and effectively resolves complex accounts with minimal supervision.
• Maintains confidentiality in regards to all patient sensitive information.
• Works on complex issues where analysis of situations or data requires in-depth evaluation of variable factors; exercises judgment in selecting methods, techniques and evaluation criteria for obtaining results; networks with key contacts outside own area of expertise.
• Acts independently to determine methods and procedures on new or special assignments.
• Performs related duties and special projects as assigned.

Qualifications

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

• High school diploma or GED required. 
• Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, customer service or similar vocations generally obtained through completion of a two-year associate’s degree program, technical vocational training, or equivalent combination of experience and education. 
• Five (5) or more years directly related and progressively responsible experience required. A two-year degree can be used in lieu of 2 years of the experience requirement; a four-year degree in lieu of 4 years of experience. Four-year degree preferred.

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

• Ability to communicate effectively both orally and in writing.
• Ability to build productive internal/external working relationships.
• Advanced interpersonal skills.
• Strong mathematical skills.
• Basic analytical skills.
• Advanced organizational skills and attention to detail.
• Extensive knowledge of pharmacy operations and medical claims.
• Excellent use of medical industry vernacular.
• General knowledge of health care billing required; advanced knowledge preferred.
• Advanced use of Microsoft Excel, Outlook, and Word.
• Developing professional expertise; applies company policies and procedures to resolve a variety of issues.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit.
• The employee must occasionally lift and/or move up to 10 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Schedule:

• 11am - 8pm

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

Artificial Intelligence in Our Recruiting and Employment Process

CareMetx uses artificial intelligence and automated decision-making technology to support parts of our recruiting, hiring, and employment process, including screening applications, scheduling interviews, and evaluating candidate qualifications. These tools support, not replace, human judgment. A qualified member of our team reviews and makes all final hiring and employment decisions.

CareMetx does not develop or use AI tools with the intent to discriminate against applicants or employees on the basis of race, color, religion, sex, age, sexual orientation, national origin, disability, veteran status, or any other protected characteristic.