[Remote] Market Access Specialist (Prior Auth and Appeals)
Note: The job is a remote job and is open to candidates in USA. SetPoint Medical is a commercial-stage medical technology company dedicated to improving care for people living with chronic autoimmune diseases. The Market Access Specialist will facilitate patient access to SetPoint Therapy by managing the pre-service clearance and prior authorization process, engaging with various healthcare providers to ensure a smooth process.
Responsibilities
ā¢ Provide excellent customer support to providers and HCO support staff, patients, and internal teams
ā¢ Review and log incoming medical record documentation, providing feedback to providers where necessary
ā¢ Verify medical benefits and facilitate the prior authorization process for company products
ā¢ Coordinate the pre-service appeals process, including composition of appeals
ā¢ Establish strong relationships with referring rheumatology practices, neurosurgery providers, hospitals and health systems to deliver best-in-class prior authorization services
ā¢ Identify payer behaviors, actions and trends that inform prior authorization approach
ā¢ Complete corporate administrative and training requirements on time and accurately
ā¢ Maintain company standards involving ethical and moral character and always represent the company with the highest professional standards
Skills
ā¢ At least 2 years' experience working in prior authorization and/or a pre-service clearance function at a medical device/pharmaceutical company, healthcare provider, or third-party market access service provider
ā¢ Excellent interpersonal communication skills
ā¢ Skilled in appeal composition and/or persuasive writing
ā¢ Understanding of medical practice management, specifically related to prior authorization portals, NPIs, electronic health records and patient/provider releases
ā¢ Knowledge of the prior authorization appeal processes that include external review, state fair hearing, and ALJ
ā¢ Awareness of State and Federal laws that impact patient and provider appeal rights, external review protocols and URAC standards
ā¢ Experience with HIPAA compliance standards for covered entities
ā¢ Understanding of Prior Authorization workflows and ability to learn and use IT systems such as Salesforce, EPIC, Cerner, etc
ā¢ Ability to work independently
ā¢ Ability to manage complexity and re-prioritize work efforts to drive efficiency and outcomes
ā¢ Ability to understand trends, identify issues, and develop corrective actions
ā¢ Ability to thrive in a fast-paced, dynamic startup environment, with a willingness to adapt to changing priorities and market conditions
ā¢ Passion for improving patient outcomes and a commitment to the company's mission and values
Company Overview
ā¢ SetPoint Medical provides a device-based therapy for rheumatoid arthritis. It was founded in 2007, and is headquartered in Valencia, California, USA, with a workforce of 51-200 employees. Its website is http://www.setpointmedical.com.
Apply Now
Apply Now
Responsibilities
ā¢ Provide excellent customer support to providers and HCO support staff, patients, and internal teams
ā¢ Review and log incoming medical record documentation, providing feedback to providers where necessary
ā¢ Verify medical benefits and facilitate the prior authorization process for company products
ā¢ Coordinate the pre-service appeals process, including composition of appeals
ā¢ Establish strong relationships with referring rheumatology practices, neurosurgery providers, hospitals and health systems to deliver best-in-class prior authorization services
ā¢ Identify payer behaviors, actions and trends that inform prior authorization approach
ā¢ Complete corporate administrative and training requirements on time and accurately
ā¢ Maintain company standards involving ethical and moral character and always represent the company with the highest professional standards
Skills
ā¢ At least 2 years' experience working in prior authorization and/or a pre-service clearance function at a medical device/pharmaceutical company, healthcare provider, or third-party market access service provider
ā¢ Excellent interpersonal communication skills
ā¢ Skilled in appeal composition and/or persuasive writing
ā¢ Understanding of medical practice management, specifically related to prior authorization portals, NPIs, electronic health records and patient/provider releases
ā¢ Knowledge of the prior authorization appeal processes that include external review, state fair hearing, and ALJ
ā¢ Awareness of State and Federal laws that impact patient and provider appeal rights, external review protocols and URAC standards
ā¢ Experience with HIPAA compliance standards for covered entities
ā¢ Understanding of Prior Authorization workflows and ability to learn and use IT systems such as Salesforce, EPIC, Cerner, etc
ā¢ Ability to work independently
ā¢ Ability to manage complexity and re-prioritize work efforts to drive efficiency and outcomes
ā¢ Ability to understand trends, identify issues, and develop corrective actions
ā¢ Ability to thrive in a fast-paced, dynamic startup environment, with a willingness to adapt to changing priorities and market conditions
ā¢ Passion for improving patient outcomes and a commitment to the company's mission and values
Company Overview
ā¢ SetPoint Medical provides a device-based therapy for rheumatoid arthritis. It was founded in 2007, and is headquartered in Valencia, California, USA, with a workforce of 51-200 employees. Its website is http://www.setpointmedical.com.
Apply Now
Apply Now