Prior Authorization Specialist

Inspire Medical Systems, Inc.; Golden Valley (MN); Remote; USD 50,000 - 70,000; Full time

Benefits offered by this job

Multiple health insurance plan options

Health Savings Account contributions

Dental, Vision, Life and Disability

401k plan + employer match

Identity protection

Flexible time off

Tuition reimbursement

Employee assistance program

Employee stock purchase program

Job summary

Inspire Medical Systems is seeking a Prior Authorization Specialist for a fully remote role in the United States. You will implement the Inspire Prior Authorization Program, ensure accurate coding and coverage questions are answered, and collaborate with Territory Managers and the prior authorization team to drive authorization success.

The role requires 2+ years in reimbursement, strong communication, and the ability to navigate payer requirements and EMR systems.

Qualifications

• 2+ years of related work experience in reimbursement.
• Knowledge of reimbursement compliance requirements.
• Ability to read, interpret, and respond to payer requirements for prior authorization.
• Ability to read, interpret, and summarize clinical and cost literature.
• Excellent written and oral communication skills.
• Proficient in Microsoft Office (Word, PowerPoint, Excel).

Responsibilities

• Support Inspire's Prior Authorization Program and enter/manage patient information.
• Assist with patient intake and verify insurance coverage.
• Call insurance providers to obtain the status of prior authorization requests.
• Work with patients and sites to pursue authorization success.
• Track and monitor progress of prior authorization requests and related EMR appeals.
• Update materials and best practices for prior authorization and EMR processes.

Skills

Reimbursement experience

Payer requirements interpretation

Clinical/cost literature review

Excellent communication

MS Office proficiency

Detail-oriented

Education

Bachelor's degree

Job description

ABOUT INSPIRE MEDICAL SYSTEMS

Inspire is the first of its kind medical device designed to make a difference in the lives of those living with Obstructive Sleep Apnea (OSA). We are revolutionizing the sleep industry with our FDA-approved medical device, designed to reduce OSA severity for those who cannot tolerate or get consistent benefit from CPAP. Inspire Medical Systems is committed to enhancing patients' lives through sleep innovation. We are steadfast in our commitment to prioritize patient outcomes, act with integrity and lead with respect. With positive persistence at our core, we are committed to all those we serve.

WHY JOIN OUR FAST-GROWING TEAM

At Inspire, we value people - your diverse experiences, backgrounds, and thoughts. We elevate voices and encourage learning opportunities to build a professional network that grows into community. We embrace a people-first culture by offering excellent benefits, 401k matching, ESPP, flexible time off (FTO), and tuition reimbursement.

If you're passionate about making a difference in people's lives and want to work with innovative technology, come be a part of our great team!

Full Remote Position

ABOUT THIS POSITION

We are recruiting for a Prior Authorization Specialist to join our team. In this role, you will be providing expertise in the area of prior authorization and will be responsible for implementing the Inspire Prior Authorization Program in the United States. You will be working with the Territory Managers and the prior authorization team to ensure all coding and coverage questions are answered correctly and concisely.

OPPORTUNITIES YOU WILL HAVE IN THIS ROLE

• Support Inspire's Prior Authorization Program, including:
  
  
  
  • Entering and managing patient information in database
  
  
  • Assisting with patient intake and verifying of insurance coverage
  
  
  • Calling insurances to obtain the status of Prior authorization requests
  
  
  • Working with patients and sites to pursue authorization success.
  
  
  
  


• Assist in tracking and monitoring progress of prior authorization requests, along with all related appeals through to EMR.


• Participate in updating the packet of materials and best practices methods to support the prior authorization and appeals processes, including External Medical Review, (EMR) for upper airway stimulation.


• Seek continuous process improvement to increase success rates and reduce time to success.


• Implement Inspire's Prior Authorization Program, including:
  
  
  
  • Training sites on program requirements
  
  
  • Entering and managing patient information in database
  
  
  • Completing prior authorization requests
  
  
  • Providing guidance to participating sites on all levels of appeals including EMR
  
  
  • Working directly with the patient to pursue EMR success.
  
  
  
  


• Provide general coding information to physician customers upon request.


• Work in conjunction with manager and staff to execute action plans and objectives to support internal/external clients.

QUALITY SYSTEM RESPONSIBILITIES

• Document product and therapy related field reports within the prescribed timelines and provide any necessary documents required to complete the investigation. Provide follow-up reporting as needed.


• Complete training requirements and competency confirmations as required for this position within the required timeline.


• Comply with applicable quality system procedures/policies and make suggestions for continuous process improvement.

WHAT YOU CAN BRING TO OUR GREAT TEAM

Required:

• 2+ years of related work experience in reimbursement


• Demonstrated knowledge of reimbursement compliance requirements and a maintaining a high level of personal integrity to promote a compliant reimbursement environment


• Ability to read, interpret and appropriately respond to payer requirements relating to prior authorization


• Ability to read, interpret and summarize clinical and cost literature


• Excellent written and oral communication skills


• Proficient in Microsoft Office applications, including Word, PowerPoint, Excel


• High attention to detail and strong team attitude


• Comfortable in a small, dynamic company environment with frequent changes in direction

Preferred:

• Bachelor's degree


• Medical device experience

Benefits and Other Compensation

Inspire offers a highly competitive benefits package including (general description of the benefits and other compensation offered):

• Multiple health insurance plan options.


• Employer contributions to Health Savings Account.


• Dental, Vision, Life and Disability benefits.


• 401k plan + employer match.


• Identity Protection.


• Flexible time off.


• Tuition Reimbursement.


• Employee Assistance program.


• All employees have the opportunity to participate in the ownership and success of Inspire. Employees at all levels can participate through equity awards and the Employee Stock Purchase Program.

Inspire Medical Systems provides equal employment opportunity (EEO) to all employees and applicants without regard to race, color, religion, creed, sex, national origin, age, disability, marital status, familial status, sexual orientation, status regarding public assistance, membership or activity in a local commission, military or veteran status, genetic information, pregnancy or childbirth, or any other status protected by applicable federal, state, and local laws. This policy applies to all aspects of the employment relationship, including recruitment, hiring, compensation, promotion, transfer, disciplinary action, layoff, return from layoff, training, and social and recreational programs. Inspire Medical Systems complies with applicable laws governing non-discrimination in employment in every location in which Inspire Medical Systems has facilities. All such employment decisions will be made without unlawfully discriminating on any prohibited basis.

Inspire Medical Systems is an equal opportunity employer with recruitment efforts focused on ensuring a diverse workforce. Applicants with a disability that need accommodation to complete the Inspire Medical Systems application process should contact Human Resources at 844-672-4357 or email careers@inspiresleep(dot)com

Inspire Medical Systems participates in E-Verify.

The salary for this position will be offered at a level consistent with the experience and qualifications of the candidate. This information reflects the anticipated salary range for this position at the time of posting. The salary range may be modified in the future and actual compensation may vary from the posting based on various factors such as geographic location, work experience, education and/or skill level.

Salary

$50,000 – $70,000 USD

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