At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives.
Reporting to the Executive Vice President of Patient Experience, the Vice President of Patient Access owns the full patient access function across every program Gifthealth operates, ensuring that prior authorizations get completed, reimbursement hurdles get cleared, and patients get to their medications faster. The VP of Patient Access owns a cross-program function built on Gifthealth's POD model, where each program operates as a copy-and-paste replica of the same high-performing access infrastructure.
We are seeking a Vice President of Patient Access to This position plays a key role in leading Patient Access, ensuring alignment with organizational goals, operational excellence, and compliance standards.
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Leads the full lifecycle of prior authorization (PA) activities across all programs, including submissions, follow-ups, appeals, and exception handling, ensuring accuracy, compliance, and timely execution across all payer types
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Designs, documents, and operationalizes repeatable, high-quality PA and reimbursement models that can be consistently deployed across existing and new programs without loss of efficiency or performance
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Oversees denial management and appeals strategy, ensuring effective resolution of access barriers while analyzing trends to drive upstream process improvements and reduce future denials
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Partners with product and engineering teams to implement ePA tools and workflow automation, approaching patient access as a product-driven function to reduce manual work and improve cycle times
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Leads reimbursement operations, including benefits verification, coverage determination, and payer landscape expertise, ensuring accurate assessments of eligibility, formulary status, and financial responsibility
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Manages bridge, copay, and patient assistance programs to ensure eligible patients are rapidly identified and enrolled, minimizing financial barriers to therapy initiation
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Owns prescriber office engagement, FRM coordination, escalation pathways, and POD model execution, ensuring consistent communication, scalable program launches, KPI accountability, and a high-quality, unified patient experience across all programs
Qualifications
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Education:
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Bachelor’s degree in business administration, operations management, or related field (Required),
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Master’s degree (Preferred)
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Licensure/Certification: None
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Experience:
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15+ years of experience in specialty pharmacy patient access, hub services, or reimbursement operations (Required)
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5+ years in a senior leadership role with direct management of PA and reimbursement teams (Required)
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Experience managing prior authorization operations across multiple payer types and therapeutic areas (Required)
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Experience in benefits verification, coverage determination, and reimbursement analysis for specialty medications (Required)
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Experience working directly with field reimbursement managers and prescriber offices in a hub or access services environment (Required)
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Experience leading teams that consistently meet or exceed PA turnaround, approval rate, and patient start time targets (Required)
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Experience in specialty pharmacy hub services or a manufacturer-sponsored patient support program environment (Preferred)
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Experience building a POD or program-replication model for patient access across multiple manufacturers or therapeutic area programs (Preferred)
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Familiarity with ePA platforms and access workflow automation tools, including direct partnership with product/engineering teams (Preferred)
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Experience in a direct-to-patient (DTP) dispensing model where patient access and pharmacy operations are closely integrated (Preferred)
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Experience with complex manufacturer-restricted access models (Preferred)
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Experience with digital transformation leading or been central to a meaningful digital transformation within a patient services or access context (Preferred)
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Experience in startup or high-growth environment experience: comfort building infrastructure while the business is running (Preferred)
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Experience working across multiple therapeutic areas simultaneously, including oncology, immunology, or rare disease (Preferred)
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Knowledge, Skills, and Abilities:
- Knowledge of advanced prior authorization optimization strategies, including automation, ePA platforms, and workflow digitization; AI and automation applications in healthcare operations, particularly in patient access and reimbursement workflows; omnichannel patient engagement approaches, including digital, SMS, and portal-based communication strategies; and pharmaceutical manufacturer operations and market access strategies, including expectations for hub performance and reporting (Preferred)
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High-volume prior authorization operation management skills, including prioritization, throughput optimization, and performance management against turnaround time and approval rate targets (Required)
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Analytical and corrective actions skills, translating data into process improvements that reduce access barriers (Required)
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End-to-end patient access workflow design and optimization skills, including identifying inefficiencies and implementing scalable solutions (Required)
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Cross-functional collaboration skills, particularly with product, engineering, field teams, and provider offices, to improve operational outcomes (Required)
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Performance measurement and reporting skills, including defining KPIs, interpreting operational data, and driving accountability within teams (Required)
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Stakeholder communication skills, including effectively interfacing with prescriber offices, field reimbursement managers (FRMs), and internal leadership (Required)
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Technology-enabled operational solution design skills, partnering with product and engineering teams to build tools that improve efficiency and user experience (Preferred)
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Standardized operating model development, including SOPs, training programs, and quality frameworks that scale across programs (Preferred)
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Patient journey mapping skills, identifying key barriers from prescription to therapy start and designing interventions to address them (Preferred)
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Modular operating models or POD building and optimizations skills for patient access delivery across multiple programs (Preferred)
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Ability to lead complex patient access operations across multiple programs, ensuring consistency, quality, and scalability (Required)
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Ability to manage and resolve complex access cases, including payer escalations and multi-stakeholder coordination (Required)
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Ability to translate payer policy and reimbursement requirements into actionable workflows and team guidance (Required)
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Ability to identify operational friction points and implement improvements that reduce time to therapy (Required)
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Ability to lead teams and drive performance in a metric-driven environment (Required)
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Ability to adapt processes and operations in response to evolving payer requirements and program needs (Required)
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Ability to think strategically about patient access as both an operational and product-driven function (Preferred)
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Ability to anticipate payer and reimbursement trends and proactively adjust operational strategy (Preferred)
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Ability to design scalable solutions that maintain consistency across diverse therapeutic areas and programs (Preferred)
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Ability to balance automation with human judgment, ensuring efficiency without compromising patient or provider experience (Preferred)
Work Environment
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Location: Hybrid / Remote
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Schedule: 8:00 A.M. to 5:00 P.M. Monday through Friday with night and weekend hours on occasion as determined by the needs of the business and cross-facility travel as needed
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Regular meetings with internal Patient Access, Quality, Compliance, Legal, Human Resources, Pharmacy, Operations, and senior leadership teams. This role may also have meetings with external vendor and consultant partner representatives.
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Must be able to remain in a stationary position for extended periods while writing or reviewing documentation
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Must be able to work on a computer for the entire shift
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Must be able to attend virtual meetings with cross-functional teams.
Status: Full-time
FLSA: Exempt
Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status.
We celebrate diversity and are committed to creating an inclusive environment for all employees. If you do not meet every requirement but still feel you would be a great fit for this role, we encourage you to apply!
This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel. Gifthealth reserves the right to modify job duties or descriptions at any time.
