Senior Patient Case Advocate

SI-BONE, Inc; San Jose (CA); Remote; USD 76,000 - 86,000; Full time

Benefits offered by this job

Stock options

Bonus

Job summary

SI-BONE, Inc is seeking a Sr. Patient Case Advocate to navigate the reimbursement process for patients seeking iFuse sacrroiliac joint fusion.

The role involves coordination with payors, surgeons, and patient teams to secure coverage and pre-authorizations while delivering high-quality customer service. The position requires extensive experience with health insurance benefits investigations and appeals, along with strong communication and documentation skills.

Qualifications

• Bachelor’s Degree preferred.
• Certified professional coder preferred.
• 10+ years’ experience with health insurance benefits investigations, and reimbursement along with billing and coding.
• Experience supporting appeals for experimental and investigational procedures.
• Excellent written and verbal communication skills.
• Assist patients with understanding what they need, listen and communicate with insurance providers, doctors, nurses and specialists, and relay this information back to their clients.
• Excellent customer service skills with a focus on assisting patients in a healthcare environment.

Responsibilities

• Acts as a patient advocate to help patients navigate the reimbursement process to obtain access to minimally invasive SI Joint fusion surgery with iFuse implants.
• Partner with Area Reimbursement Manager on case authorization and appeal strategies.
• Provide effective collaboration as the liaison between the patient, surgeons/surgeons’ offices and payor to coordinate attempt to secure coverage for iFuse system implantation.
• Ensure high quality customer service and frequent interaction with surgeon offices and patients regarding case status and outcome of pre-authorizations and appeals in company’s case management program.
• Aid physician office staff and patients to complete and submit all necessary insurance forms and program applications in a timely manner.
• Provide exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Process any correspondence; ensure accurate and thorough case documentation in database.
• Coordinate securing patients supporting medical documentation, letters of medical necessity and appeal letter signatures from referring surgeons.
• Provide Territory Manager or other sales management personnel with case updates, as needed.
• Track, monitor and report the outcomes of reimbursement initiatives (example: appeal outcomes from peer – peer reviews, external [independent] medical reviews, trends, observed from the various initiatives, etc. in assigned territory).
• Other duties as assigned
• Support the SI-BONE Quality System.

Skills

Insurance benefits investigations

Reimbursement processes

Billing & coding

Communication skills

Customer service

Education

Bachelor's Degree preferred

Certified professional coder preferred

Job description

SI-BONE is a fast-growing, publicly traded medical device company that is an industry pioneer in minimally invasive sacropelvic solutions. Our mission is to help patients rise up and reach for the stars, and our vision is to work together as the global leader to make sacropelvic conditions universally recognized and effectively treated through innovation, evidence, education, and advocacy.

Job Title:Sr. Patient Case Advocate

Travel: Occasional 10% travel including team meetings, regional sales meetings and reimbursement educational events. This is a remote position.

SI-BONE® is focused on helping patients in one of the most under-served, under-diagnosed, and under-treated areas in orthopedics, the sacroiliac (SI) joint. SI-BONE developed an innovative, patented implant to fuse the SI joint. The iFuse Implant System® provides a less invasive alternative to traditional sacroiliac (SI) joint fusion surgery and has been used in over 90,000 procedures to date.

We are a medical device company that is focused on improving the lives of patients with sacroiliac pelvic conditions. We are looking for people who are passionate about our mission and who are willing to work hard to achieve it. We are also looking for people who are:

• Agile: We work in a fast-paced environment and need to be able to learn and adapt to change quickly.
• Creative: We embrace creativity, and we need people who are not afraid to challenge the status quo.
• Team Players: We roll-up our sleeves and work together as one team to achieve our goals.

General Responsibilities:

• Acts as single point of contact and voice for regional providers, patients, and the sales team.
• Investigate peer coverage policies related to SI Joint fusion.
• Ensure patient medical documentation supports the highest opportunity for a successful pre-authorization or appeal.
• Coordinates access to iFuse, conducts appropriate follow‑up and facilitates access to surgery.
• Must at all times act and conduct company business in an honest, ethical and strictly legal manner, complying with the Code of Conduct, other company policies, the AdvaMed Code and all applicable laws and regulations, whether national, regional, state or local.
• Responsible for performing all duties in compliance with all applicable worldwide regulatory requirements as included in the scope of the SI-BONE Quality Manual.

Specific Responsibilities and Skills:

• Serves as a patient advocate to help patients navigate the reimbursement process to obtain access to minimally invasive SI Joint fusion surgery with iFuse implants.
• Partner with Area Reimbursement Manager on case authorization and appeal strategies.
• Provide effective collaboration as the liaison between the patient, surgeons/surgeons’ offices and payor to coordinate attempt to secure coverage for iFuse system implantation.
• Ensure high quality customer service and frequent interaction with surgeon offices and patients regarding case status and outcome of pre-authorizations and appeals in company’s case management program.
• Aid physician office staff and patients to complete and submit all necessary insurance forms and program applications in a timely manner.
• Provide exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Process any correspondence; ensure accurate and thorough case documentation in database.
• Coordinate securing patients supporting medical documentation, letters of medical necessity and appeal letter signatures from referring surgeons.
• Provide Territory Manager or other sales management personnel with case updates, as needed.
• Track, monitor and report the outcomes of reimbursement initiatives (example: appeal outcomes from peer – peer reviews, external [independent] medical reviews, trends, observed from the various initiatives, etc. in assigned territory.
• Other duties as assigned
• Support the SI-BONE Quality System.

Knowledge, Education and Experience:

• Bachelor’s Degree preferred.
• Certified professional coder preferred.
• 10+ years’ experience with health insurance benefits investigations, and reimbursement along with billing and coding.
• Experience supporting appeals for experimental and investigational procedures.
• Excellent written and verbal communication skills.
• Assist patients with understanding what they need, listen and communicate with insurance providers, doctors, nurses and specialists, and relay this information back to their clients.
• Excellent customer service skills with a focus on assisting patients in a healthcare environment.
• Strong attention to detail, time management and organizational skills.
• Demonstrates a positive 'can do' attitude
• Possess a demonstrated ability to communicate effectively and work well with others throughout the Company.
• Possess effective problem-solving skills.
• Be known as a person who has high integrity, sound character, a tremendous work ethic and the passion to succeed.
• Knowledge and familiarity of applicable regulations/standards (e.g. ISO 13485, FDA 21 CFR 820, EU MDR 2017/745, ISO 14971) as required to perform the job function.

Salary range: $76,000-$86,000. The compensation range for this position is specific to the location and is in good faith what SI-BONE expects to pay for the position taking into account the wide variety of factors that are considered in making compensation decisions, including job-related knowledge; skillset; experience, education and training; certifications; and other relevant business and organizational factors.

Supplemental pay: bonus and stock

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in SI-BONE, Inc’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.