Prior Authorization Specialist

Inspire Medical Systems Inc.•Minneapolis, MN

8h•Remote

About The Position

Inspire Medical Systems is seeking a Prior Authorization Specialist to join their team. This fully remote position involves providing expertise in prior authorization and implementing the Inspire Prior Authorization Program in the United States. The specialist will collaborate with Territory Managers and the prior authorization team to ensure accurate coding and coverage information. The role also includes supporting the Prior Authorization Program by managing patient information, verifying insurance coverage, contacting insurance companies for authorization status, and working with patients and sites to achieve authorization success. Responsibilities extend to tracking and monitoring prior authorization requests and appeals through the EMR system, updating program materials and best practices, and seeking continuous process improvements. The specialist will also train sites on program requirements, complete authorization requests, provide guidance on appeals including External Medical Review (EMR), and work directly with patients for EMR success. Additionally, they will provide general coding information to physician customers and work with management to execute action plans. The role also has Quality System Responsibilities, including documenting product and therapy-related field reports, completing training requirements, and complying with quality system procedures.

Requirements

2+ years of related work experience in reimbursement
Demonstrated knowledge of reimbursement compliance requirements and a maintaining a high level of personal integrity to promote a compliant reimbursement environment
Ability to read, interpret and appropriately respond to payer requirements relating to prior authorization
Ability to read, interpret and summarize clinical and cost literature
Excellent written and oral communication skills
Proficient in Microsoft Office applications, including Word, PowerPoint, Excel
High attention to detail and strong team attitude
Comfortable in a small, dynamic company environment with frequent changes in direction

Nice To Haves

Bachelor’s degree
Medical device experience

Responsibilities

Entering and managing patient information in database
Assisting with patient intake and verifying of insurance coverage
Calling insurances to obtain the status of Prior authorization requests
Working with patients and sites to pursue authorization success.
Assist in tracking and monitoring progress of prior authorization requests, along with all related appeals through to EMR.
Participate in updating the packet of materials and best practices methods to support the prior authorization and appeals processes, including External Medical Review, (EMR) for upper airway stimulation.
Seek continuous process improvement to increase success rates and reduce time to success.
Training sites on program requirements
Completing prior authorization requests
Providing guidance to participating sites on all levels of appeals including EMR
Working directly with the patient to pursue EMR success.
Provide general coding information to physician customers upon request.
Work in conjunction with manager and staff to execute action plans and objectives to support internal/external clients.
Document product and therapy related field reports within the prescribed timelines and provide any necessary documents required to complete the investigation. Provide follow-up reporting as needed.
Complete training requirements and competency confirmations as required for this position within the required timeline.
Comply with applicable quality system procedures/policies and make suggestions for continuous process improvement.