Market Access Specialist, I – II

• Facilitate patient access to support the launch of SetPoint Therapy, the first neuroimmune modulation therapy to treat rheumatoid arthritis in the United States
• Manage the pre-service clearance and prior authorization process for patients seeking access to SetPoint Therapy
• Engage with patients, rheumatology providers, neurosurgery practices, and hospitals to ensure a smooth pre-service clearance process
• Provide customer support to providers, HCO support staff, patients, and internal teams
• Review and log incoming medical record documentation and provide feedback to providers where necessary
• Verify medical benefits and facilitate the prior authorization process for company products
• Coordinate the pre-service appeals process, including composing appeals
• Establish relationships with referring rheumatology practices, neurosurgery providers, hospitals, and health systems
• Identify payer behaviors, actions, and trends that inform the prior authorization approach
• Complete corporate administrative and training requirements accurately and on time
• Maintain company ethical, moral, and professional standards
• Market Access Specialist I: Execute defined access programs with moderate guidance and support payer account management
• Market Access Specialist II: Independently manage payer accounts or access workstreams and own territory-level outcomes
• Report to the Market Access Manager

Requirements

• 2+ years of relevant experience, depending on level
• 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, including prior authorization portals, NPIs, electronic health records, and patient/provider releases
• Knowledge of prior authorization appeal processes including external review, state fair hearing, and ALJ
• Awareness of State and Federal laws affecting 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 systems such as Salesforce, EPIC, and Cerner
• Ability to work independently
• Proven ability to manage complexity and reprioritize work to drive efficiency and outcomes
• Demonstrated ability to understand trends, identify issues, and develop corrective actions
• Ability to thrive in a fast-paced, dynamic startup environment and adapt to changing priorities and market conditions
• Passion for improving patient outcomes and commitment to the company’s mission and values
• Ability to perform routine physical tasks, including lifting up to 20 pounds
• Prolonged periods of sitting at a desk and working on a computer
• Must have and maintain authorization to work in the United States

Core Competencies

Demonstrates expertise in prior authorization processes and medical practice management, with a strong focus on patient access and support. Proven ability to engage with healthcare providers and manage complex workflows to improve patient outcomes.

Highest-signal resume keywords

• Prior Authorization Management
• Appeal Composition
• Medical Practice Management
• HIPAA Compliance
• Salesforce Proficiency

Hard Skills

• Prior Authorization
• Appeal Processes
• Medical Record Documentation
• Patient/Provider Releases
• Electronic Health Records
• NPI Understanding
• Workflow Management
• Data Analysis
• Complexity Management
• Market Access Programs

Soft Skills

• Interpersonal Communication
• Persuasive Writing
• Adaptability
• Problem Solving
• Efficiency Driving

Industry Keywords

• Healthcare Provider
• Medical Device
• Pharmaceutical
• Market Access
• URAC Standards
• State and Federal Laws

Tools & Technologies

• Salesforce
• EPIC
• Cerner
• Prior Authorization Portals