Prior Authorization Specialist

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

📋 Description

• Provide specialized knowledge in prior authorization and implement the Inspire Prior Authorization Program throughout the United States.

• Collaborate with Territory Managers and the prior authorization team to address coding and coverage inquiries.

• Input and manage patient data in various databases.

• Assist with patient intake processes and confirm insurance coverage.

• Contact insurance providers to check the status of prior authorization requests.

• Partner with patients and sites to achieve successful authorizations.

• Monitor and track prior authorization requests and associated appeals through External Medical Review (EMR).

• Update materials and best practices that support prior authorization and appeals procedures.

• Pursue continuous improvements to enhance success rates and minimize time to success.

• Train sites on program requirements.

• Complete prior authorization requests.

• Offer guidance to sites regarding appeals, including EMR.

• Work directly with patients to drive EMR success.

• Provide general coding information to physician clients.

• Implement action plans and objectives alongside managers and staff to support internal and external clients.

• Document field reports related to products and therapy, and provide follow-up reporting.

• Fulfill required training and competency confirmations.

• Adhere to quality system procedures and policies.

⛳️ Requirements

• Minimum of 2 years of relevant experience in reimbursement.

• Proven understanding of reimbursement compliance requirements.

• High level of personal integrity to foster a compliant reimbursement atmosphere.

• Ability to read, interpret, and adequately respond to payer requirements concerning prior authorization.

• Capability to read, interpret, and summarize clinical and cost-related literature.

• Strong written and verbal communication skills.

• Proficient in Microsoft Office applications, including Word, PowerPoint, and Excel.

• Exceptional attention to detail and a strong team-oriented mindset.

• Comfortable working in a small, dynamic company with frequent changes in direction.

• Bachelor’s degree is preferred.

• Experience with medical devices is preferred.

🏝️ Benefits

• Comprehensive benefits package.

• 401k matching program.

• Employee Stock Purchase Program (ESPP).

• Flexible time off (FTO).

• Tuition reimbursement opportunities.

• Various health insurance plan options available.

• Employer contributions to Health Savings Account.

• Dental, Vision, Life, and Disability benefits.

• 401k plan with employer match.

• Identity Protection services.

• Employee Assistance Program.

• Equity awards.

• Employee Stock Purchase Program.