SUMMARY

The Director of Patient Access will lead the team responsible for obtaining prior authorization, billing, accepting and managing pharmacy payor claims as well as the team responsible for medical payor benefit verifications and prior authorizations.

ESSENTIAL DUTIES AND RESPONSIBILITIES

include the following. Other duties may be assigned as necessary.

• Directly oversee both prescription and medical benefits teams including staffing, training, daily workflow management and other tasks as necessary
• Lead and manage the teams, holding members accountable for their performance while fostering a positive and productive work environment.
• Develop and implement reimbursement strategies that maximize revenue and ensure timely payment from payers, including private insurance, Medicare, and Medicaid.
• Oversee the management of the prior authorization process, ensuring efficient and effective handling to facilitate patient access to medications.
• Collaborate with cross-functional teams, including pharmacy operations, clinical services, and patient support, to optimize reimbursement processes and enhance patient care.
• Stay abreast of changes in reimbursement policies and regulations, ensuring compliance and adapting strategies as necessary.
• Utilize knowledge of payor portals and other relevant platforms to streamline processes and improve patient access to medications.
• Contribute to the maintenance and enhancement of CSI Pharmacy's culture of service, ensuring that all activities align with our core values and mission.
• Consistently represents the company in a professional manner.
• Maintains effective working relationships and cooperates with Company personnel.
• Adheres to the Company’s compliance requirements as stated in the policy and procedure manual and all other related policies.
• All other projects and tasks as assigned.

QUALIFICATION REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Provide the highest level of professionalism, responsiveness, and communication in order to build and maintain a high performing team that works together to achieve results.
• Must possess the ability to multi-task and frequently change direction.
• Must be able to effective lead a high performing team, maintain and increase the high standards of service at CSI Pharmacy while promoting team cohesiveness and a culture of service to each other and our patients.
• Must be able to stay laser focused on the mission of taking the best care of patients possible and willing to what is necessary to achieve this goal.
• Must not only be open to critical feedback but willing and able to give such feedback to their team in a spirit of building each member of the team into the best version of themselves.