Treatment Access Specialist

Benefits of the Treatment Access Specialist 

 •   Comprehensive medical, dental, vision, and pet insurance
 •    401(k) with 4% company match
 •    15 days of PTO including 1 Floating Holiday
 •    Monday-Friday schedule with no weekends & Hybrid  
 •    Equipment provided: laptop, two monitors, and monthly Internet stipend
 

 About the Company:            

Mindful Health Solutions is a leading outpatient psychiatry group practice dedicated to freeing patients from the burden of mental illness. We are transforming outpatient mental healthcare by providing advanced, evidence-based interventional treatments including Transcranial Magnetic Stimulation (TMS) and Esketamine therapy. TMS is an effective, non-invasive, FDA-cleared therapy for drug resistant depression. Esketamine is an FDA-approved, prescription nasal spray for patients with treatment resistant depression. Led by nationally recognized clinical experts we offer compassionate, comprehensive mental healthcare. Our medical clinics are specifically designed to provide our patients, practitioners, and employees with a modern, relaxed, people-centered experience.           

About the role:            

 In our high-volume multi-site psychiatric practice, the Treatment Access Specialist (TAS), would act as a reimbursement and care advocate for any patients with an Interventional Treatment Path, assisting them with any pre- and post-treatment care coordination, awareness, benefit questions and authorization submission/approval. The Treatment Access Specialist will work closely with patients, providers, and insurance companies to support member access to appropriate quality and cost-effective care. Interventional Treatments managed by the Treatment Access Specialist include: Transcranial Magnetic Stimulation (TMS) - a non-drug therapy used to treat patients with drug-resistant depression and Esketamine (ESK) via SPRAVATO® a prescription medicine, administered by nasal spray, and used along with an antidepressant to treat Adults with treatment-resistant depression (TRD).
 
Responsibilities
 

•  Respond and access more complex TMS/ESK cases and account specific requests while using appropriate insurance screening criteria knowledge and clinical judgment 
•  Educate and support the individual and their family through telephonic assessment, tele-video and in-person consultations 
•  Complete the necessary prior authorizations and correspondence required by insurance companies to approve patients for TMS/ESK therapy 
•  Conduct assessments to identify individual needs and work with the provider to execute a financial reimbursement plan that matches the goals outlined in the treatment care plan 
•  Participates in cross-functional teams projects and initiatives 
•  Track patient progress verify insurance coverage through benefits investigations, schedule patients and obtain prior authorization or pre-certification 
•  Coordinates care across the continuum (Front Desk, Technicians, Provider, Denial Management Specialist) to assure appropriate utilization of clinical and community resources 
•  Participates on a team for data collections, health outcomes reporting, clinical audits, and programmatic evaluation related to initiatives 
•  In conjunction with the practice team, identifies patients at risk for poor outcomes or patients experiencing poor coordination of services who would benefit from more intensive follow-up 
•  Draft and submit appeals as needed that require careful wording 
   
   

Qualifications
 

•  Bachelor's Degree required, or equivalent combination of education, training, and relevant experience 
•  Strong customer service skills and exceptional phone presence 
•  Ability and desire to adapt and learn quickly 
•  Proficient with Microsoft Word, Excel, and essential computer capabilities. 
•  Excellent written/verbal skills along with interpersonal skills with physicians, patients, co-workers, referral sources, and leadership 
•  Minimum two years’ experience in a medical office environment center is preferred with familiarity with medical terminology 
•  Experience obtaining prior authorizations for medical services, preferred 
•  Ability to interact with potential patients, clinic staff, physicians, insurance companies and other support departments in a professional manner 
•  Ability to multi-task with high degree of attention to detail and bring tasks to completion 
•  Must respect and adhere to office guidelines and use good judgment regarding patient records and confidentiality.
•  Candidates considered for this role must live in Los Angeles/Orange County or Sacramento 
   
  Pay range: $23.00 to $24.00 per hour.   
  This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. The employee may be eligible for bonuses and other forms of compensation.