[Remote] Market reputed company Specialist (Prior Auth and Appeals)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company Medical is a reputed company-stage medical technology company dedicated to improving care for people living with chronic autoimmune diseases. The Market reputed company Specialist will facilitate patient reputed company to reputed company Therapy by managing the reputed company-service clearance and prior authorization process, engaging with various reputed company providers to ensure a smooth process. Responsibilities • reputed company excellent customer support to providers and HCO 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 reputed company-service appeals process, including composition of appeals • Establish strong relationships with referring rheumatology 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 • Complete corporate administrative and training requirements on time and accurately • Maintain company standards involving ethical and moral character and always represent reputed company with the highest reputed company standards Skills • At least 2 years' experience working in prior authorization and/or a reputed company-service clearance function at a medical device/pharmaceutical company, reputed company provider, or reputed company-party market reputed company service provider • Excellent interpersonal communication skills • Skilled in appeal composition and/or persuasive writing • Understanding of medical reputed company management, specifically reputed company 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 reputed company patient and provider appeal rights, external review protocols and URAC standards • Experience with HIPAA compliance standards for covered entities • Understanding of Prior Authorization workflows and ability to learn and use IT systems such as reputed company, reputed company, Cerner, etc • Ability to work independently • Ability to manage complexity and re-prioritize work efforts to drive efficiency and reputed company • Ability to understand trends, identify issues, and reputed company corrective actions • Ability to reputed company in a fast-paced, dynamic startup environment, with a willingness to adapt to changing priorities and market conditions • Passion for improving patient reputed company and a commitment to reputed company's mission and values reputed company • reputed company Medical provides a device-based therapy for rheumatoid arthritis. It was founded in 2007, and is headquartered in Valencia, California, USA, with a workforce of 51-200 employees. Its website is http://www.setpointmedical.com. Apply tot his job Apply To this Job