[Remote] Market Access Specialist (Prior Auth and Appeals)

Note: The job is a remote job and is open to candidates in USA. SetPoint Medical is a commercial-stage medical technology company dedicated to improving care for people living with chronic autoimmune diseases. The Market Access Specialist will facilitate patient access to SetPoint Therapy by managing the pre-service clearance and prior authorization process, engaging with various healthcare providers to ensure a smooth process.

Responsibilities
• Provide excellent customer support to providers and HCO support staff, patients, and internal teams
• Review and log incoming medical record documentation, providing feedback to providers where necessary
• Verify medical benefits and facilitate the prior authorization process for company products
• Coordinate the pre-service appeals process, including composition of appeals
• Establish strong relationships with referring rheumatology practices, neurosurgery providers, hospitals and health systems to deliver best-in-class prior authorization services
• Identify payer behaviors, actions and trends that inform prior authorization approach
• Complete corporate administrative and training requirements on time and accurately
• Maintain company standards involving ethical and moral character and always represent the company with the highest professional standards

Skills
• At least 2 years' experience working in prior authorization and/or a pre-service clearance function at a medical device/pharmaceutical company, healthcare provider, or third-party market access service provider
• Excellent interpersonal communication skills
• Skilled in appeal composition and/or persuasive writing
• Understanding of medical practice management, specifically related to prior authorization portals, NPIs, electronic health records and patient/provider releases
• Knowledge of the prior authorization appeal processes that include external review, state fair hearing, and ALJ
• Awareness of State and Federal laws that impact patient and provider appeal rights, external review protocols and URAC standards
• Experience with HIPAA compliance standards for covered entities
• Understanding of Prior Authorization workflows and ability to learn and use IT systems such as Salesforce, EPIC, Cerner, etc
• Ability to work independently
• Ability to manage complexity and re-prioritize work efforts to drive efficiency and outcomes
• Ability to understand trends, identify issues, and develop corrective actions
• Ability to thrive in a fast-paced, dynamic startup environment, with a willingness to adapt to changing priorities and market conditions
• Passion for improving patient outcomes and a commitment to the company's mission and values

Company Overview
• SetPoint Medical provides a device-based therapy for rheumatoid arthritis. It was founded in 2007, and is headquartered in Valencia, California, USA, with a workforce of 51-200 employees. Its website is http://www.setpointmedical.com.

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