Market Access Specialist, I – II

Jobtailor; Deutschland; Remote; EUR 52.000 - 78.000; Vollzeit

Zusammenfassung

SetPoint Therapy seeks a Market Access professional to support access programs for its neuroimmune therapy. You will manage pre-service clearance, prior authorizations, and appeals while coordinating with providers, hospitals, and payer teams to ensure smooth patient access.

The role requires strong communication, medical record handling, and familiarity with PA portals and EHRs. You will work in a fast-paced startup environment, driving payer-related outcomes and maintaining high professional

Qualifikationen

• 2+ years of relevant experience.
• Experience in prior authorization and/or pre-service clearance in healthcare.
• Excellent interpersonal communication skills.
• Skilled in appeal composition and persuasive writing.
• Understanding of medical practice management including PA portals, NPIs, and EHRs.
• Knowledge of PA appeal processes including external review, state fair hearing, and ALJ.
• Awareness of state and federal laws affecting appeals and URAC standards.
• HIPAA compliance experience.
• Understanding PA workflows; ability to learn Salesforce, EPIC, Cerner.
• Ability to work independently and manage complexity to drive outcomes.
• Ability to thrive in a fast-paced startup environment.
• Commitment to improving patient outcomes.

Aufgaben

• Facilitate patient access to support launch of SetPoint Therapy.
• Manage pre-service clearance and prior authorization processes.
• Engage with patients, rheumatology providers, neurosurgery practices, and hospitals.
• Provide customer support to providers, staff, patients, and internal teams.
• Review and log incoming medical records; provide feedback to providers.
• Verify medical benefits and facilitate prior authorization.
• Coordinate pre-service appeals, including composing appeals.
• Establish relationships with referring practices and hospitals.
• Identify payer behaviors informing PA approach.
• Complete corporate administrative and training requirements.
• Maintain ethical and professional standards.
• Execute defined access programs with moderate guidance (Specialist I).
• Independently manage payer accounts/workstreams and territory outcomes (Specialist II).
• Report to the Market Access Manager.

Kenntnisse

Prior Authorization

Appeal Processes

Medical Record Documentation

Patient/Provider Releases

Electronic Health Records

NPI Understanding

Workflow Management

Data Analysis

Complexity Management

Market Access Programs

Tools

Salesforce

EPIC

Cerner

Prior Authorization Portals

Jobbeschreibung

• Facilitate patient access to support the launch of SetPoint Therapy, the first neuroimmune modulation therapy to treat rheumatoid arthritis in the United States
• Manage the pre-service clearance and prior authorization process for patients seeking access to SetPoint Therapy
• Engage with patients, rheumatology providers, neurosurgery practices, and hospitals to ensure a smooth pre-service clearance process
• Provide customer support to providers, HCO support staff, patients, and internal teams
• Review and log incoming medical record documentation and provide feedback to providers where necessary
• Verify medical benefits and facilitate the prior authorization process for company products
• Coordinate the pre-service appeals process, including composing appeals
• Establish relationships with referring rheumatology practices, neurosurgery providers, hospitals, and health systems
• Identify payer behaviors, actions, and trends that inform the prior authorization approach
• Complete corporate administrative and training requirements accurately and on time
• Maintain company ethical, moral, and professional standards
• Market Access Specialist I: Execute defined access programs with moderate guidance and support payer account management
• Market Access Specialist II: Independently manage payer accounts or access workstreams and own territory-level outcomes
• Report to the Market Access Manager

Requirements

• 2+ years of relevant experience, depending on level
• 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, including prior authorization portals, NPIs, electronic health records, and patient/provider releases
• Knowledge of prior authorization appeal processes including external review, state fair hearing, and ALJ
• Awareness of State and Federal laws affecting patient and provider appeal rights, external review protocols, and URAC standards
• Experience with HIPAA compliance standards for covered entities
• Understanding of prior authorization workflows and ability to learn and use systems such as Salesforce, EPIC, and Cerner
• Ability to work independently
• Proven ability to manage complexity and reprioritize work to drive efficiency and outcomes
• Demonstrated ability to understand trends, identify issues, and develop corrective actions
• Ability to thrive in a fast-paced, dynamic startup environment and adapt to changing priorities and market conditions
• Passion for improving patient outcomes and commitment to the company’s mission and values
• Ability to perform routine physical tasks, including lifting up to 20 pounds
• Prolonged periods of sitting at a desk and working on a computer
• Must have and maintain authorization to work in the United States

Core Competencies

Demonstrates expertise in prior authorization processes and medical practice management, with a strong focus on patient access and support. Proven ability to engage with healthcare providers and manage complex workflows to improve patient outcomes.

Highest-signal resume keywords

• Prior Authorization Management
• Appeal Composition
• Medical Practice Management
• HIPAA Compliance
• Salesforce Proficiency

Hard Skills

• Prior Authorization
• Appeal Processes
• Medical Record Documentation
• Patient/Provider Releases
• Electronic Health Records
• NPI Understanding
• Workflow Management
• Data Analysis
• Complexity Management
• Market Access Programs

Soft Skills

• Interpersonal Communication
• Persuasive Writing
• Adaptability
• Problem Solving
• Efficiency Driving

Industry Keywords

• Healthcare Provider
• Medical Device
• Pharmaceutical
• Market Access
• URAC Standards
• State and Federal Laws

Tools & Technologies

• Salesforce
• EPIC
• Cerner
• Prior Authorization Portals