The Patient Access Specialist is responsible for obtaining pre-certifications, pre-authorizations and/or pre-determinations for a novel, FDA-approved medical device implant procedure. This position requires the ability to submit prior authorizations and all levels of appeal, including IRO reviews, for both facilities and professionals. Processing of post-service appeals may be required. Occasional partnership with external attorneys supporting ALJ hearings is required, as well. One aspect of this role will also include performing a portion of the prior authorization for CCM implants as an in-house function.

How You'll Add Value:

• Contact insurance companies to verify patients' insurance eligibility and petition for pre-service medical necessity review based on carriers' published medical necessity guidelines.
• Request, track and obtain pre-authorization from insurance carriers within time allotted for surgical implants using payor websites, 3rd party online portals or over the phone.
• Provide written documentation of authorization to contacts at provider offices thoroughly and promptly.
• Demonstrate and apply knowledge of medical terminology, CPT and ICD-10 codes, as well as high proficiency of general medical office procedures.
• Understand and observe patient privacy guidelines related to HIPAA and other relevant regulations.
• Maintain a high level of productivity in a remote setting without direct supervision on a daily basis.
• Clearly document all communications and contacts with providers, insurance company personnel and team members in standardized documentation methods, including proper format.
• Other duties as assigned.

What You're Bringing With You:

• This position requires a bachelor's degree or 3 -5 years of experience working in a medical practice, 3rd party patient advocacy firm or healthcare system, including dealing directly with the insurance authorization process. Direct experience with patient care and participation in patient support groups are helpful but not essential.
• Operational competence with Office suite of products, especially Outlook, Word and Excel
• Basic experience with SalesForce.com is a plus
• Working knowledge of the prior authorization process for commercial insurance and Medicare Advantage products, as well as relevant patient privacy regulations
• Ability to understand, assess and influence work flows regarding the authorization process at practices prescribing CCM implants
• Excellent organization and focus on details
• Superior oral and written communication skills