Strategic Access Specialist bei None

Palmetto Infusion provides comprehensive ambulatory and home-based infusion services to both acute and chronically ill patients. Our centers care for people by providing patients and their families with a convenient, affordable, and safe place to receive infusion treatments. We strive for more than personal service – always delivering a warm and attentive health care experience that boosts patients’ state-of-mind, improves their health, and quality of life.

At Palmetto Infusion, we believe in creating an experience that goes beyond just a job. It's about being part of something bigger than yourself - a connected group of caretakers who work together to restore health and hope to our patients. We call it The Palmetto Experience, and we believe it's what sets us apart from other employers.

For our employees, The Palmetto Experience means we serve and support people in our purpose to restore health and hope, we build a culture of belonging and collaboration, we deliver on our promise to treat people with respect and empathy, and we strive to embrace change and search for new opportunities.

About the Role:

The Strategic Access Specialist is responsible for managing new patient referrals and supporting existing patients to ensure timely access to prescribed therapies. This role includes processing referrals/orders, verifying insurance benefits, enrolling patients in assistance programs, and coordinating the start of care with patients, providers, and internal teams. They work closely with manufacturer hubs and other partners to streamline communication and help patients overcome barriers to treatment.

Schedule: Monday – Friday; 8:00 AM – 5:00 PM.

Minimum Qualifications:

Experience/Education:

• High School Diploma or Equivalent.
• 1 year of medical insurance case management or patient assistance experience.
• Proficient at partner programs (i.e.: MS Outlook, Word, Excel).
• Ability to cope with ambiguous, changing environment while under pressure in a calm manner.
• Must be able to work as a team member and develop productive and cooperative working relationships with all members of the Palmetto Infusion team.

Essential Functions:

• Manages the entire referral coordination workflow, ensuring timely processing of new orders including insurance verification, prior authorizations, and predeterminations as required.
•  Collaborates with strategic manufacturer partners and HUB programs to coordinate patient access, enrollment, and ongoing care support.
• Participates in regular review meetings with manufacturer teams to ensure alignment with program goals and service standards.
• Obtains necessary patient data and documentation from referral sources to support medical necessity and payer requirements, referencing payer medical policies and/or FDA guidelines.
• Performs initial insurance review and documents the rationale supporting approval or denial of infusion services in the EMR based on payer or FDA criteria.
• Assists patients with enrollment and re-enrollment in copay, grant, or manufacturer assistance programs, as well as evaluating eligibility for free-drug or ship-in programs.
• Completes and distributes Insurance Benefit Summaries (IBS) to appropriate clinic locations and staff.
• Prepares and reviews Advance Beneficiary Notices (ABN) with patients when required, ensuring understanding of patient responsibility.
• Utilizes the EMR system exclusively to document and communicate all patient-related information accurately and in a timely manner.
• Demonstrates a working knowledge of insurance documents and terminology, including Explanation of Benefits (EOB), copays, coinsurance, and deductibles.
• Maintains up-to-date knowledge of medical and payer practices through continuing education, staff meetings, and workshops.
• Supports Palmetto Infusion’s marketing and business development efforts by assisting the sales team and providing education materials to referral sources as requested.
• Ensures all documentation is accurate, complete, and timely to support compliance, reporting, and quality performance measures.

About the Benefits:

• Competitive Compensation
• Comprehensive Medical Insurance
• Dental and Vision Insurance
• Company Life Insurance
• Voluntary Life and Disability Insurance
• Additional Voluntary Supplemental Plans
• Flexible Spending Account (Medical and Dependent Care)
• Health Savings Account
• 401K Retirement Plan
• Employee Assistance Program (EAP)
• Employee Discounts
• Ramsey SmartDollar Program
• Referral Program
• Tuition Assistance
• Paid Time Off
• 8 Paid Company Holidays

Patient Advocacy Statement:

At Palmetto Infusion, we believe that patient advocacy is at the heart of everything we do, regardless of our roles within the organization. Each member of our team is dedicated to putting the needs and well-being of our patients first. Whether we're working directly with patients or supporting them behind the scenes, our commitment to being a compassionate advocate is paramount. We understand that every interaction, every decision, and every effort contribute to the quality of care our patients receive. 

Together, we strive to ensure that every individual feels heard, supported, and empowered throughout their healthcare journey. This dedication to patient-centered care is what creates "The Palmetto Experience" — a standard of excellence that defines us and enriches the lives of those we serve.

Physical Demands:

• • The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk, and hear. There may be prolonged periods of sitting, keyboarding, reading, as well as driving or riding in transport vehicles. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include reading, distance, computer, and color vision. Talking and hearing are essential to communicate with patients, vendors, and staff.