Note: The job is a remote job and is open to candidates in USA. SetPoint Medical is a commercial-stage medical technology company dedicated to improving care for people living with chronic autoimmune diseases. The Market Access Specialist will facilitate patient access to SetPoint Therapy by managing the pre-service clearance and prior authorization process, engaging with various healthcare providers to ensure a smooth process. Responsibilities • Provide 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 pre-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 the company with the highest professional standards Skills • At least 2 years' experience working in prior authorization and/or a pre-service clearance function at a medical device/pharmaceutical company, healthcare provider, or third-party market access service provider • Excellent interpersonal communication skills • Skilled in appeal composition and/or persuasive writing • Understanding of medical practice management, specifically related 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 impact 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 Salesforce, EPIC, Cerner, etc • Ability to work independently • Ability to manage complexity and re-prioritize work efforts to drive efficiency and outcomes • Ability to understand trends, identify issues, and develop corrective actions • Ability to thrive in a fast-paced, dynamic startup environment, with a willingness to adapt to changing priorities and market conditions • Passion for improving patient outcomes and a commitment to the company's mission and values Company Overview • SetPoint 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 Apply tot his job