Market Access Specialist

Job Responsibilities: Provide excellent customer support to providers and 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 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.

Minimum Qualifications: 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.