Patient Access Appeals Specialist

Globus Medical•Collegeville, PA

10d

About The Position

At Globus Medical, we move with a sense of urgency to deliver innovations that improve the quality of life of patients with musculoskeletal disorders. Our team is inspired by the needs of these patients, and the surgeons and healthcare providers who treat them. We embrace a culture of exceptional response by partnering with researchers and educators to transform clinical insights into tangible solutions. Our solutions improve the techniques and outcomes of surgery so patients can resume their lives as quickly as possible. Nevro (A subsidiary of Globus Medical) is a global medical device company . We are focused on delivering comprehensive, life-changing solutions that continue to set the standard for enduring patient outcomes in chronic pain treatment. The company started with a simple mission to help more patients suffering from debilitating pain and developed its proprietary 10 kHz Therapy, an evidence-based, non-pharmacologic innovation that has impacted the lives of more than 100,000 patients globally. Nevro’s comprehensive HFX™ spinal cord stimulation (SCS) platform includes a Senza SCS system and support services for the treatment of chronic trunk and limb pain and painful diabetic neuropathy. Senza®, Senza II®, Senza Omnia™, and Senza HFX iQ™ are the only SCS systems that deliver Nevro's proprietary 10 kHz Therapy. HFX iQ, Nevro’s latest innovation, is the first and only SCS System that uses Artificial Intelligence to optimize and maintain pain relief using each patient's response1.Nevro’s unique support services provide every patient with an HFX Coach™ throughout their pain relief journey and every physician with HFX Cloud™ insights for enhanced patient and practice management. Position Summary: The Patient Access Appeals Specialist is part of the HFX Access team, playing a critical role in securing payer coverage for patients. The Patient Access Appeals Specialist will work in collaboration with HFX Access, Market Access and Field personnel to provide customer support from prior authorization submission through final appeals process .

Requirements

Bachelor’s degree in related field
2+ years of applicable experience in reimbursement support relating to appeals and prior authorizations from a payer, provider or medical device/pharmaceutical industry required
Must demonstrate the ability to draft professional and effective appeal letters
Prior experience and knowledge of health insurance business, industry terminology, and regulatory guidelines
Required to sit; climb or balance; and stoop, kneel, crouch or crawl
Required to regularly lift and/or move up to 10 pounds, and occasionally lift and/or move up to 25 pounds
Required to possess specific visons abilities, including: close vision, distance vision, color vision, peripheral vision, depth perception and capacity to adjust focus

Nice To Haves

Prior patient appeals experience is preferred
Prior experience with Medicare, Medicaid, TRICARE, Workers Compensation and Commercial Insurance is preferred

Responsibilities

Partner with internal partners, to secure HFX Access and drive effective pull-through with payers
Meet metrics and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Develop sound and well-supported appeal argument letters of patient appeal based on payer policy
Thoroughly review medical records and other documentation provided by physicians for completeness and can recognize information that is missing that is necessary for submitting an appeal
In conjunction with GAMA and HFX Access team members, stay current on payer coverage policies and patient requirements for HFX therapy as well as stay current on impact of health care reform to patient’s access to HFX therapy
Leverage knowledge of applicable medical policies, Nevro clinical publications, and other resources that can be used to strengthen appeals
Respond to all patient, physician, office staff, and field communications in a timely manner
Provides timely updates about the case status to the field representative and customer contact
Provide complete review of payer communication for assigned patient case (i.e., approval and denial letters) and shares findings with local sales team and customer contact
Monitors to ensure that all problems with appeals/grievances presented by plan members/participants are resolved in accordance with established policies and procedures
Responsible for reporting all complaints regarding products to the appropriate Company personnel within the required time frames
Perform other duties as required
Ensuring compliance with company Compliance policy, in particular patient confidentiality (HIPAA) in all team practices
Adheres to the letter and spirit of the company Code of Conduct, the AdvaMed Code, MedTech Code, and all other company policies.
Ensures Compliance with applicable governmental laws, rules, and regulations, both in the United States and internationally, by completing introductory and annual training and maintaining knowledge of compliance as it applies to your role
Represents the company in a professional manner and uphold the highest standards of ethical business practices and socially responsible conduct in all interactions with other employees, customers, suppliers, and other third parties
Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.