Prior Authorization Specialist

Summary

Join CVRx as a Prior Authorization Specialist and play a critical role in ensuring seamless patient access to care. You will manage prior authorizations, reauthorizations, and appeals, maintain accurate documentation, and liaise with insurance representatives. This dynamic role also involves onboarding new sites, overseeing multiple cases, and keeping the sales team informed. The ideal candidate thrives in a fast-paced environment and is passionate about making a difference in healthcare. Responsibilities include managing Barostim prior authorizations, driving process improvement, strategic collaboration, and navigating payer requirements. The position offers competitive salary and benefits, including health and dental insurance, 401k matching, paid time off, and flexible schedules.

Requirements

• High School Diploma
• Previous prior authorization and reimbursement experience
• Knowledge of medical and claims processing terminology
• Excellent written/verbal communication, including ability to provide clear instructions
• Must be able to work independently with high attention to detail and processes
• Strong critical thinking and problem solving skills
• Comfortable working in a small start-up company with a dynamic environment and frequent changes in direction
• Knowledge of reimbursement compliance requirements and ability to maintain a high level of personal integrity to promote a compliant reimbursement environment

Responsibilities

• Accurately entering and maintaining consumer information in the database
• Assisting with consumer intake and verifying insurance coverage
• Communicating with insurance companies to track the status of authorization requests
• Collaborating with consumers and sites to achieve successful authorizations
• Driving process improvement: Continuously refining workflows to boost success rates and accelerate authorization timelines
• Strategic collaboration: Partnering with the manager and HCA team to execute effective action plans and objectives
• Onboarding and updates: Streamlining the onboarding of new sites and providing timely case updates to sales teams
• Navigating payer requirements: Interpreting and responding to payer guidelines to ensure compliance and maximize outcomes

Preferred Qualifications

• Bachelor’s degree or four (4) or more years of relevant experience in prior authorization and appeal requests
• Experience modifying and updating processes and systems for the purpose of improving program effectiveness

Benefits

• Competitive Health & Dental Insurance options with generous Company contributions
• Company contributions to an HSA with a high deductible insurance plan selection
• 401(k) with a company match
• Employee stock purchase plan & stock option grants
• 12 company-paid holidays per year in addition to accruing PTO
• Generous paid time off for new parents
• Company-paid life insurance & disability options
• Unlimited growth opportunities
• Training & learning opportunities
• Flexible Schedules