Provides education and support to HCPs and their offices regarding access and affordability programs according to their geography and aligned accounts as part of the hub services team. Manages daily activities that support appropriate patient access to products in providers offices. Functions as a liaison to other patient assistance and reimbursement support services. Collaborates with other patient services, market access, sales leadership and field teams where appropriate to ensure best-in-class patient services.• Supports the entire reimbursement journey from patient enrollment or initiation, access determination, payer prior authorization to appeals/denials requirements procedures.• Provides engagements using a multi-channel approach to enhance HCP experience, using approved tools, to support and address questions about coverage requirements.• Educates HCP’s and office staff on available patient assistance programs and explains the importance of their role in facilitating access to therapy for appropriate, eligible patients. This may include training on web-based provider tools.• Serves as payer and pharmacy expert for defined geography and proactively communicates changes to key stakeholders, both internal and external. • Identifies market access trends from local, regional, or national payers in assigned geography, and partners with internal and client teams to enable appropriate patient access and/or support patient pull-through programs. • Maintains and grows knowledge of national, regional, local and account market dynamics including coverage and prior authorization requirements, as well as specialty pharmacy channels.• Analyzes data and disseminates insights with local field teams, and home office functions regarding customer needs, potential barriers, and payer issues/opportunities for product access. • Executes business in accordance with client values to the highest ethical, legal and compliance standards.

Managed a caseload of 250-plus patients for those going through the onboarding process and those already on therapy. Hosted bi-weekly meetings with Sales, Clinical Educators, and Patient Access to efficiently move pending cases forward. Provided ongoing counsel to providers, patients, and families to address access barriers and reimbursement concerns. • Led a 30-person team through the Annual Benefit Reverification project consisting of over 10,000 patients, which achieved maintaining accurate patient insurance information and identified payer trends for the new calendar year.• Served as Vendor Management’s Designated Point Person, fielding the patient services team’s inquiries and instructing on best practices for resolution, or escalating to Vendor Management team.• Provided expertise cross functionally to field representatives and providers regarding prior authorization requirements including medical necessity, diagnosis and procedure codes, and supporting lab work to streamline the process.• Worked with specialty pharmacies and insurance companies to verify patients’ benefits, authorization requirements and status, appropriate specialty pharmacy triage, and shipment status. • Designed a suite of evergreen team email templates to ensure quality and consistent communication with the patient and directed team training sessions to convey proper use.• Trained peers through two-month new-hire onboarding and mentored in Peer-to-Peer program.• Performed REMS during onboarding for providers and patients to accurately maintain FDA compliance.• Created job aids and SOPs for Patient Services Department as selected Member of Quality and Effectiveness practicum.• Guided Natpara drug recall by compassionately counseling 300-plus patients regarding modified protocols.• Hosted and presented at off-site patient meetings and liaised with healthcare provider offices to review support services, troubleshoot accounts, and build rapport.

Utilized monthly ageing reports to reconcile adjustments, claim denials, partial payments, and identify payer trends.• Verified insurance benefits including coverage, authorization requirements, and medical necessity criteria.• Worked with patients, providers, and field staff to resolve complex reimbursement issues to ensure continuous treatment.• Documented detailed account history and maintained current account information on all patients in the company database according to compliance regulations.• Submitted claim appeals and authorization requests verbally or via written request with appropriate supporting documentation.• Supported and collaborated with other departments and field representatives to provide top-tier support.

Counseled patients at up to 10 dialysis facilities during open enrollment to optimize insurance elections and aided in financial assistance applications for American Kidney Fund. Submitted prior authorizations and appeals for coverage approval.• Wrote coverage exception letter requests on behalf of patients who had plan exclusions or only out of network benefits and was granted approvals resulting in significantly increased revenue and patient satisfaction.• Counseled patients regarding insurance benefits, onboarding steps, and resources for additional financial support and community programs.• Verified patient insurance coverage and benefits and partnered with field staff to resolve insurance issues.