Patient Access Specialist - Robinson TWP
Job Summary
The Patient Access Specialist oversees the patient’s financial journey from start to finish, including benefits investigation, prior authorization support, and enrollment in financial assistance programs. This role manages inbound and outbound communication with patients, prescriber offices, and third-party providers to clarify medical and pharmacy coverage, benefits, and related inquiries, ensuring all interactions are handled efficiently and courteously. Key responsibilities include resolving complex insurance rejections that require follow-up with patients, providers, and payors; managing the full authorization process—prior authorizations, appeals, and medical tier exceptions—by initiating, reviewing, submitting, tracking, and following up on requests. The specialist coordinates enrollment in manufacturer-sponsored assistance programs and other financial support resources, serving as a liaison between patients, healthcare providers, insurance companies, and program sponsors to ensure accurate documentation and timely processing.
Job Responsibility- Confirm patient coverage for pharmacy and medical benefits, including eligibility, co-pays, deductibles, secondary insurance, and network status. Identify and explain available financial assistance programs.
- Initiate, complete, and track prior authorizations, medical tier exceptions, and appeals. Prepare documentation, collaborate with providers and payors, and ensure adherence to timelines for approvals and denials.
- Submit accurate claims for reimbursement, resolve non-clinical payor rejections (e.g., plan limits, coverage terminations), and address benefit discrepancies between insurance providers.
- Collect and submit required documentation for copay cards, patient assistance, and other support programs. Monitor renewals, educate patients and providers on eligibility, and resolve delays or denials.
- Act as a liaison among patients, providers, and payors to clarify benefits, coverage, and next steps. Provide empathetic, patient-centered support for those navigating financial or medical challenges.
- Maintain accurate records of interactions, outcomes, and program details.
- Escalate complex cases to management or program sponsors as needed.
- Escalate all concerns of adverse events and product quality concerns to the clinical team.
- Ensure compliance with HIPAA regulations and organizational polices.
- Crosstrain and provide support in other key functions within the organization where needed.
- Participate in post-onboarding training and development as needed to enhance skills and performance.
About Walgreens
Founded in 1901, Walgreens (www.walgreens.com) proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.
Basic Qualifications
- High school diploma from an accredited school or equivalent GED.
- Licensed or registered in the state in which they reside, if required.
- At least 1 year of work experience in healthcare, specialty pharmacy, PBM and/or call center settings.
- Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction in healthcare, specialty pharmacy, PBM, call center setting or other related industry.
- Ability to communicate clearly and effectively (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential manner.
- Basic level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line).
Preferred Qualifications
- Experience providing customer service in a healthcare, specialty pharmacy, PBM, call center setting or other related industry including but not limited to adherence, quality, etc.
- Experience in identifying operational issues and recommending and implementing strategies to resolve problems.
- Familiarity of medical terminology, prescriptions, and pharmacy regulations.
- Intermediate level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line)
We will consider employment of qualified applicants with arrest and conviction records.
Salary Range: $16.5 - $22 / Hourly
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