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Are you looking to make a meaningful impact on the lives of stroke survivors? Are you organized, customer-focused and interested in joining a high-performing team in a start-up environment? MicroTransponder, inc. is seeking a highly motivated Senior Prior Authorization Specialist to help bring a new therapy to stroke survivors the Vivistim Paired VNS Therapy.

The Senior Prior Authorization Specialist plays a very important role at MicroTransponder; to ensure patient access to Vivistim Paired VNS Therapy throughout a network of providers who are similarly committed to improving the lives of patients suffering from chronic stroke. The Senior Prior Authorization Specialist is responsible for working directly with providers to manage the pre-service clearance process for candidates for Vivistim Paired VNS Therapy. This role will report to the Market Access Manager and will work closely with our field teams. As part of the Market Access & Reimbursement team, this role will also help support the pre-service clearance program as needed.

Requirements

This position will be primarily remote and will require occasional (2-3X per year) travel to company offices.

Position Responsibilities/Essential Functions:

• Develop awareness and understanding of the coverage policy landscape for vagus nerve stimulation (VNS) and rehabilitation therapies to treat upper limb deficit in patients with chronic stroke symptoms
• Contact insurance carriers to verify patients insurance eligibility, benefits and requirements for Vivistim Paired VNS Therapy
• Obtain, document and store appropriate patient medical records from multiple offices and sources
• Request, track and obtain pre-authorization from insurance carriers within time allotted
• Initiate and follow-up on appeals for denied authorizations
• Provide resources to ensure accuracy of CPT, HCPCS, and ICD-10 diagnosis
• Clearly document all communications and contacts with providers office, patient, sales team and MicroTransponder personnel in databases
• Leveraging insurance coverage databases, identify and communicate any insurance changes or trends among team
• Support hospital and rehabilitation clinics to identify and appeal denied services including provision of denial appeal templates
• Demonstrate and apply knowledge of medical terminology
• High proficiency in medical office operations including HIPAA regulations
• Respond to clinic questions regarding payer medical policy guidelines and authorization status
• Other duties as assigned

Qualifications:

• You should have a strong understanding of pre-service clearance procedures and processes and be able to apply that in a fast-paced environment. This position requires careful attention to detail and regular updates, occasional presentations to senior management and strong communication skills are required of this strong team player.
• Experience in medical front-office operations and/or pre-service clearance
• Experience in reviewing, handling and storing medical record documentation and awareness of HIPAA compliance programs
• Demonstrated acumen and success in securing prior authorization, ideally for neurostimulation implant surgery and/or rehabilitation services
• Experience and understanding of the billing process for hospital and/or physician services to Medicare and commercial insurance plans
• Preferred Qualifications:
• Experience in claims processing, billing, patient financial services and claim denial appeals
• Experience with SalesForce, EPIC Systems or other EHR/ERP systems
• An understanding of the hospital revenue cycle, including; charge capture processes, claim generation, pre-bill edits, claims submission and accounts receivable/collection activities in hospital and physician practices large and small

Education & WorkRequirements

• Bachelors degree or combination of education and highly relevant experience
• 2 years of medical prior authorization experience preferred
• 2 years experience in a medical related field required
• Additional Preferred Qualifications
• Coding certification (i.e. CPC) and/or practice management designations (i.e. RHIA, RHIT, PACS)
• Startup or small company experience
• Neurostimulation or rehabilitation experience

MicroTransponder, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Benefits

This is a full-time role with competitive compensation that is commensurate with experience.