The Patient Access Specialist is responsible for various functions in support of patient access to the SPRINT PNS System including but not limited to collaborating with payers, providers, patients, field sales representatives and other functional areas within the company. Through our SPRcare Patient Access Program, the Patient Access Specialist will provide exceptional support to internal and external customers, verify benefits and eligibility, collect supportive clinical documentation for the facilitation of authorizations and/or pre-service appeals, and process decisions from payers.

PRIMARY RESPONSIBILITIES

• Provide superior customer support to external customers, patient candidates, and the internal SPR Sales Organization
• Verify medical benefits and facilitate authorization process fulfilling payer requirements to enable access to treatment
• Facilitate pre-service appeal requests for commercial insurance companies, government payers, workers compensation, and liability insurance for coverage of SPRINT PNS
• Follow-up and track all requests to insurance companies
• Provide frequent and on-going communications to providers, patients, payers, and internal teams
• Provide frequent and on-going communications to providers, patients, payers, and internal teams
• Coordinate with providers and patients to obtain appropriate authorizations and necessary documentation related to the patient access process
• Assist in identifying and analyzing payer trends/issues impacting patient and market access
• Maintain precise documentation in databases and files
• Perform other duties and projects as assigned by management

KNOWLEDGE AND SKILL REQUIREMENTS

Experience, Competencies, Education:

• A minimum of 2 years of related health insurance experience in one or more of the following areas: coverage, health insurance claims, prior authorization, reimbursement, and verification of benefits for Medicare, Medicaid, and Commercial payers
• Preferred knowledge of medical benefits, insurance standards, investigation processes, and compliance requirements for reimbursement for Medicare, Medicaid, Commercial, Workers Compensation, and liability insurances
• Knowledge of HIPAA and related patient privacy laws
• Proficiency in Microsoft Office Software, email programs, and online information systems

Beneficial Skills and Experience:

• Medical Device experience preferred
• Customer Service and/or Call Center experience a plus
• Experience working in a CRM platform, ideally Salesforce, preferred

WORKING CONDITIONS

• Ability and willingness to “get the job done”, allowing for flexible and extended hours, depending upon the project needs
• Small office environment (does own documentation and interacts directly with others in virtually all situations)
• Remote flexibility up to 2 days/week
• Travel – less than 10%