MedTech Coding Specialist, Patient Access Program (PAP) Operations

Coverage And Coding Access Specialist

MCRA is part of IQVIA MedTech. As a trusted CRO and advisory partner, IQVIA MedTech and MCRA deliver integrated lifecycle solutions for the medical device and diagnostics industry. Together, we support innovation from concept to commercialization, offering expertise in regulatory strategy, clinical trial design and execution, market access, and post-market optimization. Our teams combine deep therapeutic knowledge with advanced data and technology to help clients make smarter decisions and thrive in the market. Join our team to help shape the future of MedTech.

The Coverage and Coding Access Specialist is a dynamic, public-facing role that is focused on supporting a variety of patient access and reimbursement functions, with an emphasis on researching and responding to a diverse range of coding and coverage inquiries from clients, healthcare providers, and patients seeking access to innovative diagnostic and therapeutic interventions. Excellent oral and written communication skills combined with exceptional customer service skills are essential functions for this position.

Responsibilities and Duties

• Provide positive, proactive service to the company's Patient Access Solutions (PAS) clients in support of coding hotlines and coverage access programs.
• Perform intake of cases and capture all relevant research and correspondence in the company's CRM
• Answers technical coding, coverage, and reimbursement questions from providers, billing and coding staff, and sales representatives
• Stay abreast of current trends in coding and coverage support pathways for new technologies with continuing education and coding forum reviews
• Facilitate Coverage Access support to patients including performing benefit investigations, pre-authorization and denied claims appeals, in an efficient and timely manner
• Provide recurring education about the technologies and procedures supported by PAS to physicians, hospitals, patients, and other stakeholders as may be required to effect timely access to care
• Research and interpret payer coverage policies, medical necessity criteria, coding guidelines, and reimbursement requirements for assigned technologies.
• Provide exceptional customer service to internal and external customers; resolve any customer requests in a timely and accurate manner; escalates complaints accordingly
• Adhere to all HIPAA compliance policies
• Ensure all work products comply fully with related guidelines, regulations, standards, policies, and mission of the company.

Required Knowledge, Skills, and Experience

• Associate degree required/B.S. or B.A. preferred
• 2+ years of experience in health care, preferably in a physician practice or facility
• Coding certification (such as CPC or CPC-A) required
• Knowledge of CPT, HCPCS, ICD-10-CM, and ICD-10-PCS.
• Experience in health care in an administrative capacity is highly desirable, preferably in a physician practice or facility applying knowledge of billing code systems and claims processing
• Proficiency with MS Office Suite, including PowerPoint, Excel, Word, and Outlook
• Excellent oral and written communication skills
• Strong analytical and documentation proficiencies
• Ability to work effectively in a team and home environment
• Detail and process-oriented, with analytical and documentation proficiencies
• Self-directed individual able to manage client engagements with minimal supervision
• Demonstrates strong patient advocacy skills, and client interaction skills
• Ability to analyze complex reimbursement scenarios and communicate findings clearly to diverse audiences.
• Ability to work outside of traditional business hours if needed
• Potential for travel to the company's office, for meetings, and conferences.

NOTE: This job description is not intended to be all-inclusive. Employee may perform other related duties as to meet the ongoing needs of the organization.