Market Access Specialist, I – II

This is a fully remote position, open to applicants in California.

📋 Description

• Facilitate patient access to support the introduction of SetPoint Therapy, the pioneering neuroimmune modulation therapy for rheumatoid arthritis in the United States.

• Oversee the pre-service clearance and prior authorization process for patients who wish to access SetPoint Therapy.

• Collaborate with patients, rheumatology providers, neurosurgery practices, and hospitals to ensure an efficient pre-service clearance process.

• Provide customer support to providers, healthcare organization support staff, patients, and internal teams.

• Examine and document incoming medical record information, offering feedback to providers when necessary.

• Verify medical benefits and assist in the prior authorization process for the company's products.

• Coordinate the pre-service appeals process, including drafting appeals.

• Build relationships with referring rheumatology practices, neurosurgery providers, hospitals, and health systems.

• Analyze payer behaviors, actions, and trends to inform the prior authorization strategy.

• Complete corporate administrative and training requirements accurately and punctually.

• Uphold the company’s ethical, moral, and professional standards.

• Market Access Specialist I: Implement defined access programs with moderate guidance and support in payer account management.

• Market Access Specialist II: Independently oversee payer accounts or access workstreams and take responsibility for territory-level outcomes.

• Report to the Market Access Manager.

⛳️ Requirements

• 2+ years of relevant experience, depending on the level.

• Experience in prior authorization and/or a pre-service clearance function within a medical device/pharmaceutical company, healthcare provider, or third-party market access service provider.

• Outstanding interpersonal communication skills.

• Proficient in appeal composition and/or persuasive writing.

• Knowledge of medical practice management, including prior authorization portals, NPIs, electronic health records, and patient/provider releases.

• Familiarity with prior authorization appeal processes, including external review, state fair hearing, and ALJ.

• Understanding of State and Federal laws impacting patient and provider appeal rights, external review protocols, and URAC standards.

• Experience with HIPAA compliance standards for covered entities.

• Knowledge of prior authorization workflows and capability to learn and utilize systems such as Salesforce, EPIC, and Cerner.

• Ability to work independently.

• Proven capability to manage complexity and reprioritize tasks to enhance efficiency and outcomes.

• Demonstrated ability to recognize trends, identify issues, and formulate corrective actions.

• Ability to excel in a fast-paced, dynamic startup environment while adapting to evolving priorities and market conditions.

• Commitment to improving patient outcomes and alignment with the company’s mission and values.

• Capacity to perform routine physical tasks, including lifting up to 20 pounds.

• Ability to sit for prolonged periods at a desk and work on a computer.

• Must possess and maintain authorization to work in the United States.

🏝️ Benefits

• Fully remote work arrangement.

• Occasional travel up to 10%, including trips to Company Headquarters in Valencia, CA.

• Equal opportunity employer with a commitment to diversity.