Patient Access Specialist - Coherus

JOB TITLE: Patient Access Specialist

EMPLOYER: AssistRx

DEPARTMENT: Patient Solutions

REPORTS TO: Supervisor, Patient Solutions

EFFECTIVE DATE: 03/31/2023

REVIEWED DATE: 05/09/2025

SUMMARY: The Patient Access Specialist is responsible for processing applications, introducing the assistance program, conducting benefit investigation for patients, and navigating complex reimbursement issues including initial entry of patient data into the system, looking up insurance benefits, contacting insurers, advising the healthcare provider and/or patient of patients’ benefits, and identifying patient access barriers and seeking resources to overcome barriers; leading and participating in pilots, new initiatives, special projects, and cross functional teams.

DUTIES AND RESPONSIBILITIES:

• Answers inbound calls and makes outbound calls to introduce services.
• Gathers patient data, addresses the needs of the patient and reviews insurance benefits. 
• Records the call details in patient data system. 
• Contacts insurers for verification of benefits.
• Handles difficult patient situations when they arise.
• Conducts follow-up with pharmacies.
• Performs other related duties as assigned by management.

SUPERVISORY RESPONSIBILITIES:

QUALIFICATIONS:

• Associate degree (AA) or equivalent from a two-year college or technical school, or six months to one-year related experience and/or training, or equivalent combination of education and experience.
• Computer skills: Microsoft Office Suite.
• 2 to 4 years of benefit investigation involving the analysis and interpretation of insurance coverage preferred.
• 2 to 4 years of experience interacting with healthcare providers regarding health insurance plan requirements preferred.
• Pharmacy background/call center/health insurance or MD office experience preferred.
• Exposure to enrollment, pre-assessment & benefits' processes preferred.
• Part D claim experience preferred.

COMPETENCIES:

• Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
• Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
• Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
• Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

• Occasionally required to stand.
• Occasionally required to walk.
• Frequently required to sit.
• Continually required to utilize hand and finger dexterity.
• Continually required to talk or hear.
• While performing the duties of this job, the noise level in the work environment is usually moderate.
• Specific vision abilities required by this job include: Close vision and the ability to adjust focus.
• Work is performed in a traditional commercial office setting with standard office lighting and white noise.
• Additional remarks regarding work environment:
  • This job operates in a professional office environment.

The above is intended to describe the general content of and requirements for the performance of this job.  It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements.  Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.