Job Summary:

The Patient Access Specialist oversees the patient’s coverage 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 insurance companies 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, prescribers, 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, prescribers, insurance companies, and program sponsors to ensure accurate documentation and timely processing.

Job Responsibilities:- Provides primary support and resolution for escalated issues and challenging cases.

• Documents contact interactions, records details, complaints, comments, and actions taken.
• Resolves questions and problems submitted by customers, Pharmacy Benefit Manager (PBM) and medical plans following established guidelines and standard SOPs and procedures. Utilizes all available information to choose the best solutions and resolve customer and plan concerns.
• Assists with managing the Stat Board to ensure stat requests are handled in a timely manner.
• Responds to all levels of inbound Pharmacy Benefit Manager and Major Medical insurance related phone calls
• Provides red hat support as needed (such as providing support to team members during critical implementations such as system changes / updates).
• Facilitates non-reimbursement windshields for PBM and major medical claims to include internal errors and patient complaints.
• Willing to conduct quality monitoring and audits of team, or provide temporary backup to department Supervisor, as needed.
• Provides assistance related to training new hires or departmental training, or specialized pharma programs (such as PBM plans, Major Medical, Specialized Pharma programs, etc.).
• Assists with Work in Progress (WIP) and workflow coordination.
• Monitors reporting and takes action as needed.
• Participates in monitoring the health of assigned workflow areas in order to make recommendations for action; provides follow-up on previous action plans to gauge effectiveness and integrate lessons into future approach recommendations (e.g. WIP analysis).
• Applies business knowledge to existing data products/reports to understand apparent cause of anomalies and recommendations for process or system enhancements (e.g. WIP outlier investigations).
• Conducts side by side review and coaching.
• Provides support in remediating issues found in area of expertise, documenting findings and sharing results of executed action plans (e.g. WIP Analysis FAQ's).

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/GED.
• Currently meeting or exceeding established quality and productivity standards with 6 months experience as an Insurance Verification Specialist.
• At least 1 year of experience providing customer service (such as adherence, complex disease states quality, After Call Work (ACW), etc.) 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.
• At least 1 year of experience with effective communication (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential manner.
• Experience in identifying operational issues and recommending and implementing strategies to resolve problems.
• 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).

Preferred Qualifications

• At least 1 year experience with providing customer service related to adherence, complex disease states quality, After Call Work (ACW), etc.
• Advanced 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).
• Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates.
  We will consider employment of qualified applicants with arrest and conviction records.

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Salary Range: $18.25 - $24.35 / Hourly