Description

Position Description:

The Market Access Specialist will facilitate patient access to support the launch of a one of a kind, category defining technology.

This role will manage the pre-service clearance and prior authorization process for patients seeking access to out client's Therapy. This will include engagement with patients, providers, neurosurgery practices, and hospitals to ensure a smooth pre-service clearance process. This position is remote and will report to the Senior Manager of Market Access.

Job Responsibilities

• Provide excellent customer support to providers and support staff, patients, and internal teams.
• Review and log incoming medical record documentation, providing feedback to providers where necessary.
• Verify medical benefits and facilitate the prior authorization process for company products.
• Coordinate the pre-service appeals process, including composition of appeals.
• Establish strong relationships with referring practices, neurosurgery providers, hospitals and health systems to deliver best-in-class prior authorization services.
• Identify payer behaviors, actions and trends that inform prior authorization approach.

Minimum Qualifications

• 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.
• Excellent interpersonal communication skills.
• Skilled in appeal composition and/or persuasive writing.
• Understanding of medical practice management, specifically related to prior authorization portals, NPIs, electronic health records and patient/provider releases.
• Knowledge of the prior authorization appeal processes that include external review, state fair hearing, and ALJ.
• Awareness of State and Federal laws that impact patient and provider appeal rights, external review protocols and URAC standards.