Director, Patient Access
Director, Patient Access
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$ 127200 - 212000
1 Vacancy
Job Description
Position Overview
MCRA an IQVIA business is currently seeking a Patient Access Program (PAP) Operations leader to lead our Patient Access Programs and role requires leadership program management and day to day administrative and operational oversight of the Patient Access Team and all associated activity with the team. Under the general direction of the VP RHEMA this candidate will lead and provide oversight to the Patient Access Team who are responsible for collaborating with providers and patients conducting benefit verifications prior authorization submissions and follow ups initiating and following up on claim appeals (all levels) and also answering general coding questions that come through the support line for new and novel technologies using a CAT III CPT code or an unlisted CAT I CPT code.
The Director Patient Access Program Operations is also responsible for designing and implementing patient access programs following an established framework in addition to all ongoing program activities including client escalations monthly metric calls and program reporting and data. This role asks that you contribute to the development of administrative functions including workflows policies and procedures staff training and documentation.
This is a leadership position in a fast-paced results driven environment.
Through MCRA supported training and continuing education reimbursement personnel are required to become experts in the disease states of spine orthopedics biologics cardiovascular and other areas affected by specific clinical/surgical interventions treatment alternatives and the technologies themselves.
Responsibilities
- Provide proactive leadership administrative and operational support to MCRAs Patient Access Program (PAP) team and clients.
- Ensures all incoming cases are logged in system and assigned to the appropriate Case Manager.
- Confirms all assigned cases are worked within the established service level agreement guideline.
- Communicates with PAP clients providers and insurers to mitigate case barriers for escalated cases.
- Updates internal SOPs and communicates these changes with team and clients as needed.
- Reviews template letter composition for quality and correctness prior to submission to health plan and or provider.
- Analyze insurer correspondence clinical notes insurance medical policies and medical device guidelines to assist case managers with case strategy formation as needed.
- Work with Finance to ensure that all billable time is accurately allocated to PAP clients and assist with invoicing matters as needed.
- Completes case auditing to ensure quality of data collection and case summaries.
- Develops direct reports and seeks process improvement opportunities to improve and optimize workflows.
- Meets with PAP clients monthly to review program metrics and performance. In addition to supplying monthly reports package to all PAP clients.
- Assist with new program design development and implementation.
- Attends Business Development calls for prospective PAP clients.
- Partners with other RHEMA teams for mixed cross-selling opportunities.
- Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
- Ability to complete special projects or other duties as assigned.
- Adheres to all HIPAA and PHI compliance policies.
Required Qualifications
- Bachelors Degree in Business Healthcare Administration Finance
- Coding certification (such as CPC or CPC-A) preferred
- 3 years experience working in a leadership capacity.
- 5-8 years of medical billing/coding including benefit verification prior authorization and claim appeals.
- Familiarity with medical terminology and coding i.e. CPT HCPCS ICD-10.
- Understanding of CMS -1500 claim forms prior authorization forms and appeals forms for claims adjudication.
- Deep payer research skills using tools such as Policy Reporter etc.
- Working knowledge of federal and commercial insurance products procedures claims process and medical policies.
- Professional demeanor and communications skills both oral and written
- 5 years of managing a team delegating work and checking work quality. Including experience with developing people processes and administering corrective action and performance improvement plans.
- Proficiency with MS Office Suite including Word PowerPoint Excel Word and Outlook
- Self-directed individual who demonstrates initiative and can manage assignments with little oversight. Demonstrates effective time management skills and the ability to manage multiple priorities and assignments.
- Results oriented and metric driven.
- Moderate understanding of HIPAA and PHI handling practices.
- Ability to work effectively leading a team in office and remotely.
Preferred Qualifications
- Understanding of how to use Payer portals such as NaviNet Avality CMS (CEDI) UHC etc.
- Knowledge of medical device biopharmaceutical billing.
- Experience working administratively within a health care setting is highly desirable preferably for a health insurer physician practice ambulatory care center and/or hospital facility.
- Ability to work with broad spectrum of diagnoses coding.
- CPC Certification not required but highly preferred.
IQVIA is a leading global provider of clinical research services commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at
IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability status as a protected veteran or any other status protected by applicable law. potential base pay range for this role when annualized is $127200.00 - $212000.00. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge skills education and experience; location; and/or schedule (full or part-time). Dependent on the position offered incentive plans bonuses and/or other forms of compensation may be offered in addition to a range of health and welfare and/or other benefits.
Required Experience:
Director
Employment Type
Full-Time
