Patient Access Specialist

globusmedical; Pennsylvania; On-site; USD 42,000 - 60,000; Full time

Job summary

Nevro, a global medical device company and subsidiary of Globus Medical, seeks a Patient Access Specialist to support payer coverage through the full prior authorization process and appeals.

You will review documentation, ensure HIPAA compliance, and provide timely customer service while coordinating with physicians and care teams to navigate coverage requirements.

Qualifications

• Bachelor's degree or equivalent work experience in health economics, life sciences, public health, public policy, finance, business or marketing.
• 1-2 years of customer service, patient access, or prior authorization experience.
• Experience with regulatory requirements and patient confidentiality (HIPAA).
• Experience relating to appeals and prior authorizations from payer, provider, or medical device/pharmaceutical industry.

Responsibilities

• Provide payer coverage support from initial documentation to prior authorization and appeals.
• Perform detailed claims review and hotline support.
• Ensure excellent customer service and follow-up on all assigned work.
• Meet regional metrics and stay current on payer coverage policies and HF10 therapy requirements.
• Maintain HIPAA compliance in all activities.

Skills

Customer service

Communication skills

Team collaboration

Analytical thinking

Attention to detail

Education

Bachelor's degree

Job description

At Globus Medical, we move with a sense of urgency to deliver innovations that improve the quality of life of patients with musculoskeletal disorders. Our team is inspired by the needs of these patients, and the surgeons and healthcare providers who treat them. We embrace a culture of exceptional response by partnering with researchers and educators to transform clinical insights into tangible solutions. Our solutions improve the techniques and outcomes of surgery so patients can resume their lives as quickly as possible.

Nevro (A subsidiary of Globus Medical) is a global medical device company. We are focused on delivering comprehensive, life-changing solutions that continue to set the standard for enduring patient outcomes in chronic pain treatment. The company started with a simple mission to help more patients suffering from debilitating pain and developed its proprietary 10 kHz Therapy, an evidence-based, non-pharmacologic innovation that has impacted the lives of more than 100,000 patients globally.

Nevro's comprehensive HFX™ spinal cord stimulation (SCS) platform includes a Senza SCS system and support services for the treatment of chronic trunk and limb pain and painful diabetic neuropathy. Senza®, Senza II®, Senza Omnia™, and Senza HFX iQ™ are the only SCS systems that deliver Nevro's proprietary 10 kHz Therapy. HFX iQ, Nevro's latest innovation, is the first and only SCS System that uses Artificial Intelligence to optimize and maintain pain relief using each patient's response1.Nevro's unique support services provide every patient with an HFX Coach™ throughout their pain relief journey and every physician with HFX Cloud™ insights for enhanced patient and practice management.

Position Summary :

The Patient Access Specialist will focus on providing payer coverage support to customers from the initial processing of received documentation through prior authorization, appeals support, detailed claims review, and hotline support. The Patient Access Specialist will be responsible for providing payer coverage expertise and support regarding all phases of the prior authorization process, appeals, and all related patient access activities with all types of customers. The Patient Access Specialist will be responsible for providing excellent customer service and follow-up on all assigned work. The Specialist will also be responsible for meeting required metrics to ensure quality service to all customer types.

Essential Functions :

• The Patient Access Specialist will adhere to quality of HFX Access service through QA, additional training and process improvement.
• Work in conjunction with the Supervisor to focus on realistic and achievable turn-around times for all department functions.
• Review documentation provided by physicians for completeness and have the ability to recognize information that is missing that is necessary for completing a case
• Meet and/or exceed metrics in designated region to ensure quality service to all customer types.
• Provide necessary documentation and follow up in order to support the prior authorization and appeal process as well as provide education to customers regarding payer coverage requirements.
• In conjunction with other team members, stay current on payer coverage policies and patient requirements for HF10 therapy as well as stay current on impact of health care reform to patient's access to HF10 therapy.
• Ensure compliance with company compliance policy, in particular patient confidentiality (HIPAA) in all HFX Access practices.
• Perform other duties as required
• Adheres to the letter and spirit of the company Code of Conduct, the AdvaMed Code, MedTech Code, and all other company policies.
• Ensures Compliance with applicable governmental laws, rules, and regulations, both in the United States and internationally, by completing introductory and annual training and maintaining knowledge of compliance as it applies to your role
• Represents the company in a professional manner and uphold the highest standards of ethical business practices and socially responsible conduct in all interactions with other employees, customers, suppliers, and other third parties

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

Qualifications :

• Bachelor's Degree (health economics, life sciences, public health, public policy, finance, business or marketing disciplines) or equivalent work experience.
• 1-2 years of customer service, patient access, or prior authorization experience.
• Experience complying with regulatory requirements and company policy in dealing with the customer and patient confidentiality.
• Applicable experience in customer service and/or reimbursement support relating to appeals and prior authorizations from a payer, provider, or medical device/pharmaceutical industry.
• Ability to work with various teams to accomplish organizational goals.
• Excellent communication skills, both verbal and written.
• Analytically focused with a hig