Summary

The Patient Access Specialist will focus on providing payer coverage support to customers from the initial processing of received documentation through prior authorization, appeals support, detailed claims review, and hotline support. The Patient Access Specialist will be responsible for providing payer coverage expertise and support regarding all phases of the prior authorization process, appeals, and all related patient access activities with all types of customers. The Patient Access Specialist will be responsible for providing excellent customer service and follow-up on all assigned work. The Specialist will also be responsible for meeting required metrics to ensure quality service to all customer types.

Job description

Position Summary

The Patient Access Specialist will focus on providing payer coverage support to customers from the initial processing of received documentation through prior authorization, appeals support, detailed claims review, and hotline support. The Patient Access Specialist will be responsible for providing payer coverage expertise and support regarding all phases of the prior authorization process, appeals, and all related patient access activities with all types of customers. The Patient Access Specialist will be responsible for providing excellent customer service and follow-up on all assigned work. The Specialist will also be responsible for meeting required metrics to ensure quality service to all customer types.

Essential Functions

Adhere to quality of HFX Access service through QA, additional training and process improvement
Work in conjunction with the Supervisor to focus on realistic and achievable turn-around times for all department functions
Review documentation provided by physicians for completeness and recognize missing information necessary for completing a case
Meet and/or exceed metrics in designated region to ensure quality service to all customer types
Provide necessary documentation and follow up to support the prior authorization and appeal process and educate customers regarding payer coverage requirements
Stay current on payer coverage policies and patient requirements for HF10 therapy as well as impact of health care reform on patient access
Ensure compliance with company compliance policy, in particular patient confidentiality (HIPAA) in all HFX Access practices
Perform other duties as required
Adhere to the company Code of Conduct, the AdvaMed Code, MedTech Code, and all other company policies
Ensure compliance with applicable governmental laws, rules, and regulations by completing introductory and annual training
Represent the company in a professional manner and uphold the highest standards of ethical business practices

Qualifications

Bachelor's Degree (health economics, life sciences, public health, public policy, finance, business or marketing disciplines) or equivalent work experience
1-2 years of customer service, patient access, or prior authorization experience
Experience complying with regulatory requirements and company policy in dealing with customer and patient confidentiality
Applicable experience in customer service and/or reimbursement support relating to appeals and prior authorizations from a payer, provider, or medical device/pharmaceutical industry
Ability to work with various teams to accomplish organizational goals
Excellent communication skills, both verbal and written
Analytically focused with a high attention to detail
Ability to follow work processes
Must be courteous, professional and balanced with a tenacious drive
Able to multitask and prioritize workflows
Excellent organizational and project management skills
Strong interpersonal skills to influence/negotiate complex decisions and demonstrate leadership
Working knowledge of medical terminology
Knowledge of HCPCS Coding
Knowledge of ICD-10 coding

Requirements

Bachelor's Degree (health economics, life sciences, public health, public policy, finance, business or marketing disciplines) or equivalent work experience
1-2 years of customer service, patient access, or prior authorization experience
Experience complying with regulatory requirements and company policy in dealing with customer and patient confidentiality
Applicable experience in customer service and/or reimbursement support relating to appeals and prior authorizations from a payer, provider, or medical device/pharmaceutical industry
Ability to work with various teams to accomplish organizational goals
Excellent communication skills, both verbal and written
Analytically focused with a high attention to detail
Ability to follow work processes
Able to multitask and prioritize workflows
Excellent organizational and project management skills
Strong interpersonal skills to influence/negotiate complex decisions and demonstrate leadership
Working knowledge of medical terminology
Knowledge of HCPCS Coding
Knowledge of ICD-10 coding

Company overview

Globus Medical, Inc. is a leading publicly traded orthopedic medical device company headquartered in Audubon, Pennsylvania, founded in 2003. The company specializes in the design, development, and commercialization of innovative musculoskeletal solutions that enable surgeons to promote healing in patients with musculoskeletal disorders. Globus Medical has established itself as the fastest growing company in the history of orthopedics through its single-minded focus on advancing surgical technologies. The company's comprehensive product portfolio includes spinal implants, trauma solutions, artificial joints, and the revolutionary ExcelsiusGPS surgical robotic system for spine surgery. Their robotic navigation technology provides sub-millimeter accuracy for transpedicular drilling and screw placement procedures. Globus Medical also offers advanced surgical planning software and registry solutions like SpineTRACK and OrthoTRACK for comprehensive treatment outcomes data collection. The company's mission is to utilize superior engineering and technology to achieve pain-free, active lives for all patients, driving significant technological advancements across a complete suite of orthopedic products.