Patient Access Liaison

Role Overview

As a Patient Access Liaison, you will serve as a dedicated advocate, helping patients navigate and overcome obstacles to obtain and maintain their prescribed treatments. This position focuses on aiding patients by guiding them through insurance processes, coordinating with specialty pharmacies, connecting them with financial support options, and ensuring smooth treatment logistics. Your role requires a compassionate yet knowledgeable approach, creating a positive experience for patients while fostering strong relationships with healthcare providers, pharmacies, and internal teams.

Key Responsibilities

• Establish trust with patients through respectful, empathetic, and culturally aware communication.
• Inform patients about insurance procedures, pharmacy coordination, treatment details, and supportive programs.
• Empower patients to communicate effectively with healthcare providers, pharmacies, and insurers.
• Perform benefit verifications to assess coverage, cost-sharing, and prior authorization requirements.
• Address insurance-related challenges such as coverage exclusions, exceptions, and appeals.
• Provide payer insights to internal teams to enhance processes and eliminate access barriers.
• Explain specialty pharmacy workflows and set appropriate expectations for patients.
• Resolve issues related to shipment delays, formulary exceptions, and other access difficulties.
• Assist patients in enrolling in copay and patient assistance programs.
• Collaborate with Reimbursement Liaisons to address complex financial issues.
• Work with healthcare providers and care sites to coordinate and schedule treatments, preparing patients accordingly.
• Support patients throughout their treatment journey to ensure seamless transitions between different stages.
• Document all patient interactions in the CRM system in compliance with standard operating procedures and regulatory requirements.
• Achieve quality, response time, and patient satisfaction benchmarks while upholding HIPAA and other regulatory standards.

Qualifications and Experience

• Minimum of 8 years’ experience in patient access, reimbursement, case management, or healthcare navigation; experience in pharmaceutical, biotech, specialty pharmacy, or healthcare provider settings is preferred.
• In-depth understanding of buy-and-bill or physician-administered therapies.
• Proficient skills in benefit verification, prior authorization, appeals processing, and reimbursement strategies, including CPT/HCPCS coding.
• Experience using CRM platforms such as Salesforce and PowerBI, alongside digital communication tools.
• Familiarity with HIPAA, FDA, Office of Inspector General (OIG), and pharmacovigilance regulations.
• Preferred experience in rare diseases or ophthalmology and the ability to assist with bilateral treatment planning.
• Bachelor’s degree or higher in nursing, public health, social work, healthcare administration, life sciences, or a related discipline; advanced degrees or certifications are advantageous.
• Possession of the Prior Authorization Certified Specialist (PACS) credential is a plus.
• Bilingual skills are welcomed and may be preferred depending on patient demographics.
• Strong empathy, cultural competence, analytical problem-solving, and teamwork capabilities.
• Willingness and ability to travel up to 50% of the time.