Prior Authorization Specialist - Fully Remote

Inspire Medical Systems; United States; A distancia; USD 45.000 - 65.000; Jornada completa

Descripción de la vacante

Inspire Medical Systems is seeking a remote Prior Authorization Specialist in the United States. You will support the company’s Prior Authorization Program and work with Territory Managers to ensure correct coding and coverage decisions.

You will handle patient intake, verify insurance coverage, and pursue authorization success with insurances, patients, and sites. Responsibilities include managing PA requests and related EMR documentation, updating best practices, and guiding appeals and coding

Formación

• 2+ years of reimbursement experience.
• Knowledge of reimbursement compliance requirements.
• Ability to read and summarize payer requirements.
• Strong written and verbal communication.
• Detail-oriented with a collaborative mindset.

Responsabilidades

• Enter and manage patient information in the database.
• Assist with patient intake and verify insurance coverage.
• Call insurers to check prior authorization status.
• Coordinate with patients and sites to pursue authorization success.
• Track progress of prior authorization requests and appeals in EMR.
• Update materials and best practices for PA and appeals.
• Provide guidance on appeals including EMR.
• Collaborate with manager and staff on action plans.

Conocimientos

Reimbursement knowledge

Payer requirements interpretation

Communication skills

Attention to detail

Team collaboration

Adaptability in small teams

Herramientas

EMR systems

Microsoft Office

Descripción del empleo

Fully 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