Location: Maple Grove, Minnesota
- This position will be a combination of Maple Grove office and work from home.
- Provide ongoing training and mentoring to the SPRcare team to advance knowledge, foster career growth and expand team capabilities.
- Actively participate in the day-to-day operations of the SPRcare Program; verify benefits, facilitate authorizations and/or appeals, collect necessary documentation to fulfill payer requirements, and process payer determinations to enable patient access to SPRINT.
- Serve as the primary source of contact for patients, providers, and sales personnel for coverage and payment inquiries.
- Analyze program outcomes to identify trends that hinder patient access and craft strategic and tactical recommendations to adapt the program based on changing market access requirements and/or to improve program outcomes and efficiency.
- Provide expert level acumen on national and local payer coverage policies, coding, billing, fee schedules, and payment methodologies to support to internal and external customers.
- Research, analyze, and monitor payer policies to identify trends in coverage and/or reimbursement that impact patient access and aide in the identification of opportunities to improve access. Assist in the development and execution of strategic payer initiatives to secure coverage.
- Minimum of 5+ years’ experience within health policy and reimbursement in the implantable medical device sector with a comprehensive understanding of all aspects of health policy and reimbursement for Government and Private payers.
- Demonstrated level of billing and payment competencies including but not limited to CPT, ICD-10, HCPCS coding, CPT modifier use, and EOB interpretation.
- In-depth knowledge of medical benefits, pre- and post-service insurance processes, and requirements for coverage and payment for Government and Private payers.
- Advanced ability to locate and interpret payer coverage policies, payer coverage determination making processes, pre- and post-service review requirements, billing guidelines, and payment methodologies.
- Successful track record in market access expansion through the collaboration with internal and external customers, payers, and patients.
- Experience working in a CRM platform.
- Knowledge of HIPAA and related patient privacy laws.
Why Join Our Team?
- Entrepreneurial work environment – truly a growth oriented and collaborative atmosphere in the medical device industry
- Ability to work with game changing technology
- Competitive compensation and benefits
- Employee Wellness Program