Prior Authorization Specialist

Inspire therapy•Golden Valley, MN

2d•Remote

About The Position

Inspire Medical Systems is recruiting a Prior Authorization Specialist to provide expertise in prior authorization and implement the Inspire Prior Authorization Program in the United States. The specialist works with Territory Managers and the prior authorization team to answer coding and coverage questions accurately and concisely. This is a fully remote position. The role supports patient intake and insurance verification, manages patient information, obtains updates from insurers on prior authorization requests, and works with patients and sites to pursue authorization success. The specialist tracks requests and appeals through External Medical Review (EMR), helps maintain program materials and best practices, trains participating sites, completes prior authorization requests, and guides sites and patients through appeals. The role also provides general coding information to physician customers and works with the manager and staff to execute action plans for internal and external clients. Quality system responsibilities include documenting product- and therapy-related field reports within required timelines, supplying documents needed for investigations, providing follow-up reports as needed, completing required training and competency confirmations, complying with quality system procedures and policies, and suggesting process improvements.

Requirements

At least 2 years of related work experience in reimbursement.
Demonstrated knowledge of reimbursement compliance requirements and commitment to maintaining personal integrity in 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.
Proficiency in Microsoft Office applications, including Word, PowerPoint, and Excel.
High attention to detail and a strong team attitude.
Comfort working in a small, dynamic company environment with frequent changes in direction.

Nice To Haves

Bachelor’s degree.
Medical device experience.

Responsibilities

Support Inspire’s Prior Authorization Program.
Enter and manage 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 and monitor prior authorization requests and related appeals through External Medical Review (EMR).
Participate in updating materials and best practices for prior authorization and appeals, including EMR for upper airway stimulation.
Seek continuous process improvement to increase success rates and reduce time to success.
Train sites on program requirements.
Complete prior authorization requests.
Provide participating sites guidance on all levels of appeals, including EMR.
Work directly with patients to pursue EMR success.
Provide general coding information to physician customers upon request.
Work with the manager and staff to execute action plans and objectives supporting internal and external clients.
Document product- and therapy-related field reports within prescribed timelines and provide documents required to complete investigations.
Provide follow-up reporting as needed.
Complete required training and competency confirmations within required timelines.
Comply with applicable quality system procedures and policies and suggest continuous process improvements.