IQVIA

Patient Access Operations Lead

IQVIA • $111K — $309K *
Washington, DC 20011In-Person
Healthcare
8 - 10 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Bachelor's Degree in Business, Healthcare Administration, or Finance & a Coding certification with 8-10+ years' leadership experience.
  • 5-8 years in medical billing/coding, including benefit verification and claim appeals.
  • Familiar with medical terminology and coding systems like CPT and ICD-10.
  • Deep understanding of claims processes, including CMS-1500 and prior authorization forms.
  • Strong communication skills, both written and verbal.
  • Team management experience with a focus on quality assurance and employee development.
  • Proficiency in MS Office Suite.

Responsibilities

  • Lead and manage the Patient Access Program (PAP) team and ensure program operational effectiveness.
  • Log all incoming cases and assign them to Case Managers for timely processing.
  • Communicate with clients, providers, and insurers to remove obstacles in escalated cases.
  • Ensure internal SOPs are updated and clearly communicated with team and clients.
  • Review documentation for quality and accuracy prior to submission.
  • Analyze payer policies and clinical notes to aid in case strategy development.
  • Meet with clients monthly to review performance metrics and program effectiveness.

Benefits

  • Comprehensive training and continuing education opportunities.
  • Collaborative team environment focused on innovation.
  • Opportunity to lead in a fast-paced, results-oriented setting.
  • Engagement in program design and implementation.
  • Chance to influence healthcare accessibility for patients.
Full Job Description
Position Overview
MCRA, and IQVIA Business is currently seeking a Patient Access Program (PAP) Operations Lead to lead our Patient Access Programs and Team. This role requires leadership, program management and day to day administrative and operational oversight of the Patient Access Team and all associated activity with the team. Under the general direction of the VP, RHEMA, the Patient Access Program Operations Lead will lead and provide oversight to the Patient Access Team who are responsible for collaborating with providers and patients, conducting benefit verifications, prior authorization submissions and follow ups, initiating and following up on claim appeals (all levels) and also answering general coding questions that come through the support line for new and novel technologies using a CAT III CPT code or an unlisted CAT I CPT code.

The PAP Lead is also responsible for designing and implementing patient access programs, following an established framework, in addition to all ongoing program activities, including client escalations, monthly metric calls and program reporting and data. This role asks that you contribute to the development of administrative functions, including workflows, policies and procedures, staff training, and documentation.

This is a leadership position in a fast-paced, results driven environment. Through MCRA supported training and continuing education, reimbursement personnel are required to become experts in the disease states of spine, orthopedics, biologics, cardiovascular and other areas affected by specific clinical/surgical interventions, treatment alternatives and the technologies themselves.

Responsibilities
  • Provide proactive leadership, administrative and operational support to MCRA's Patient Access Program (PAP) team and clients.
  • Ensures all incoming cases are logged in system and assigned to the appropriate Case Manager.
  • Confirms all assigned cases are worked within the established service level agreement guideline.
  • Communicates with PAP clients, providers, and insurers to mitigate case barriers for escalated cases.
  • Updates internal SOPs and communicates these changes with team and clients as needed.
  • Reviews template letter composition for quality and correctness prior to submission to health plan and or provider.
  • Analyze insurer correspondence, clinical notes, insurance medical policies and medical device guidelines to assist case managers with case strategy formation, as needed.
  • Work with Finance to ensure that all billable time is accurately allocated to PAP clients and assist with invoicing matters, as needed.
  • Completes case auditing to ensure quality of data collection and case summaries.
  • Develops direct reports and seeks process improvement opportunities to improve and optimize workflows.
  • Meets with PAP clients monthly, to review program metrics and performance. In addition to supplying monthly reports package to all PAP clients.
  • Assist with new program design, development, and implementation.
  • Attends Business Development calls for prospective PAP clients.
  • Partners with other RHEMA teams for mixed cross-selling opportunities.
  • Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
  • Ability to complete special projects or other duties as assigned.
  • Adheres to all HIPAA and PHI compliance policies.

Required Qualifications
  • Bachelor's Degree in Business, Healthcare Administration, Finance or and Associates Degree and a Coding certification (such as CPC or CPC-A), with 8-10+ years' experience working in a leadership capacity.
  • 5-8 years of medical billing/coding, including benefit verification, prior authorization, and claim appeals.
  • Familiarity with medical terminology and coding, i.e., CPT, HCPCS, ICD-10.
  • Understanding of CMS -1500 claim forms, prior authorization forms and appeals forms for claims adjudication.
  • Deep payer research skills using tools such as Policy Reporter, etc.
  • Working knowledge of federal and commercial insurance products, procedures, claims process and medical policies.
  • Professional demeanor and communications skills both oral and written
  • 5+ years of managing a team, delegating work, and checking work quality. Including experience with developing people, processes and administering corrective action and performance improvement plans.
  • Proficiency with MS Office Suite, including Word, PowerPoint, Excel, Word, and Outlook
  • Self-directed individual who demonstrates initiative and can manage assignments with little oversight. Demonstrates effective time management skills and the ability to manage multiple priorities and assignments.
  • Results oriented and metric driven.
  • Moderate understanding of HIPAA and PHI handling practices.
  • Ability to work effectively leading a team in office and remotely.

Preferred Qualifications
  • Understanding of how to use Payer portals such as, NaviNet, Avality, CMS (CEDI), UHC, etc.
  • Knowledge of medical device, biopharmaceutical billing.
  • Experience working administratively within a health care setting is highly desirable, preferably for a health insurer, physician practice, ambulatory care center and/or hospital facility.
  • Ability to work with broad spectrum of diagnoses coding.
  • CPC Certification not required but highly preferred.


The potential base pay range for this role, when annualized, is $111,000.00 - $309,200.00. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.

About IQVIA

Innovex offers superior and creative advice to corporations. In addition, they raised venture capital for our own affiliate companies, in addition to having assisted clients in fund-raising efforts, new venture outreaches, and financing. Their engineers and technical staff offer varied backgrounds in manufacturing, high tech, product design, quality control, safety, biomechanics, and robotics.

IQVIA Careers

Join the vibrant team at IQVIA, a leading global provider of advanced analytics, technology solutions, and clinical research services to the healthcare industry. IQVIA is recognized for its commitment to innovation, leadership in healthcare, and a culture that celebrates diversity and inclusion.

Work You’ll Do

At IQVIA, we offer job opportunities that empower you to leverage your skills and drive healthcare forward. Become part of a team that thrives on innovation and the pursuit of operational excellence, helping to improve patient outcomes across the globe.

Transform Your Career

IQVIA is the place where you can transform the world of healthcare while advancing your career. With a variety of positions available, from research and development to business analytics, IQVIA is at the forefront of the industry. Our leadership is committed to fostering a culture of growth and professional development, making IQVIA a prime environment for both seasoned professionals and those seeking an internship to kickstart their career.

Innovative Work Environment

Join over 50,000 dedicated professionals in a dynamic environment where technology meets healthcare. At IQVIA, innovation isn’t just a buzzword; it's the backbone of how we solve complex challenges. With cutting-edge resources and a collaborative global team, your work at IQVIA directly contributes to advancements in life sciences.

Career Development and Benefits

IQVIA believes in nurturing its team members not just as employees but as individuals seeking to grow their careers. We support this with unmatched benefits, diversity training, and opportunities for leadership development. Our commitment to your career growth is matched by our dedication to providing a supportive and inclusive workplace.

Explore Job Opportunities

Whether you’re looking for a full-time position, part-time work, or a graduate internship, IQVIA offers a range of employment options to match your career ambitions. Our hiring process is designed to be transparent and engaging, helping you to understand where your skills can best be utilized within the company.

Networking and Professional Development

At IQVIA, networking and professional development are part of our DNA. Engage with industry leaders, participate in global conferences, and take advantage of our in-house training programs designed to enhance your skills and advance your career.

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Join Our Team Search open positions that match your skills and interests. We look for passionate, curious, creative, and solution-driven team players. Explore the diverse job opportunities at IQVIA and find where you can make an impact.

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Learn more about IQVIA
Size
82,000 employees
Market Cap
$37.5 billion
Industry
Pharmaceuticals & Biotech
Net Income
$279 million
Founded
2016
5 Year Trend
+15.3%
Revenue
$11.3 billion
NASDAQ
IQV
* Ladders Estimates

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