Prior Authorization Specialist
New
I
Inspire Medical SystemsMedical devices
Location: Golden Valley, MNFull-TimeJunior
Salary50,000 - 70,000 USD per year
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Job Details
- Experience
- 2+ years of related work experience in reimbursement
- Required Skills
- Microsoft ExcelPowerPoint
Requirements
- Bring 2+ years of related work experience in reimbursement.
- Demonstrate knowledge of reimbursement compliance requirements and maintain a high level of personal integrity in a compliant reimbursement environment.
- Read, interpret, and respond appropriately to payer requirements relating to prior authorization.
- Read, interpret, and summarize clinical and cost literature.
- Demonstrate excellent written and oral communication skills.
- Be proficient in Microsoft Office applications, including Word, PowerPoint, and Excel.
- Bring high attention to detail and a strong team attitude.
- Be comfortable working in a small, dynamic company environment with frequent changes in direction.
- Preferred: Bachelor’s degree.
- Preferred: Medical device experience.
Responsibilities
- Support Inspire’s Prior Authorization Program, including entering and managing patient information in the database.
- Assist with patient intake and verify insurance coverage.
- Contact insurers to obtain the status of prior authorization requests.
- Work with patients and sites to pursue authorization success.
- Track prior authorization requests and related appeals through External Medical Review (EMR).
- Update materials and best practices for prior authorization and appeals processes, including EMR for upper airway stimulation.
- Train participating sites on program requirements and complete prior authorization requests.
- Provide sites with guidance on appeals and work directly with patients to pursue EMR success.
- Provide general coding information to physician customers upon request.
- Document product- and therapy-related field reports, complete required training, and suggest quality-system process improvements.
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