Appeals Specialist

Patient Access Appeals Specialist

At Globus Medical, we move with a sense of urgency to deliver innovations that improve the quality of life of patients with musculoskeletal disorders. Our team is inspired by the needs of these patients, and the surgeons and healthcare providers who treat them. We embrace a culture of exceptional response by partnering with researchers and educators to transform clinical insights into tangible solutions. Our solutions improve the techniques and outcomes of surgery so patients can resume their lives as quickly as possible.

Nevro (A subsidiary of Globus Medical) is a global medical device company. We are focused on delivering comprehensive, life-changing solutions that continue to set the standard for enduring patient outcomes in chronic pain treatment. The company started with a simple mission to help more patients suffering from debilitating pain and developed its proprietary 10 kHz Therapy, an evidence-based, non-pharmacologic innovation that has impacted the lives of more than 100,000 patients globally.

Nevro's comprehensive HFX spinal cord stimulation (SCS) platform includes a Senza SCS system and support services for the treatment of chronic trunk and limb pain and painful diabetic neuropathy. Senza, Senza II, Senza Omnia, and Senza HFX iQ are the only SCS systems that deliver Nevro's proprietary 10 kHz Therapy. HFX iQ, Nevro's latest innovation, is the first and only SCS System that uses Artificial Intelligence to optimize and maintain pain relief using each patient's response. Nevro's unique support services provide every patient with an HFX Coach throughout their pain relief journey and every physician with HFX Cloud insights for enhanced patient and practice management.

Position Summary:

The Patient Access Appeals Specialist is part of the HFX Access team, playing a critical role in securing payer coverage for patients. The Patient Access Appeals Specialist will work in collaboration with HFX Access, Market Access and Field personnel to provide customer support from prior authorization submission through final appeals process.

Essential Functions :

• Partner with internal partners, to secure HFX Access and drive effective pull-through with payers
• Meet metrics and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
• Develop sound and well-supported appeal argument letters of patient appeal based on payer policy
• Thoroughly review medical records and other documentation provided by physicians for completeness and can recognize information that is missing that is necessary for submitting an appeal
• In conjunction with GAMA and HFX Access team members, stay current on payer coverage policies and patient requirements for HFX therapy as well as stay current on impact of health care reform to patient's access to HFX therapy
• Leverage knowledge of applicable medical policies, Nevro clinical publications, and other resources that can be used to strengthen appeals
• Respond to all patient, physician, office staff, and field communications in a timely manner
• Provides timely updates about the case status to the field representative and customer contact
• Provide complete review of payer communication for assigned patient case (i.e., approval and denial letters) and shares findings with local sales team and customer contact
• Monitors to ensure that all problems with appeals/grievances presented by plan members/participants are resolved in accordance with established policies and procedures
• Responsible for reporting all complaints regarding products to the appropriate Company personnel within the required time frames
• Perform other duties as required
• Ensuring compliance with company Compliance policy, in particular patient confidentiality (HIPAA) in all team practices
• Adheres to the letter and spirit of the company Code of Conduct, the AdvaMed Code, MedTech Code, and all other company policies.
• Ensures Compliance with applicable governmental laws, rules, and regulations, both in the United States and internationally, by completing introductory and annual training and maintaining knowledge of compliance as it applies to your role
• Represents the company in a professional manner and uphold the highest standards of ethical business practices and socially responsible conduct in all interactions with other employees, customers, suppliers, and other third parties

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

Qualifications :

• Bachelor's degree in related field
• 2+ years of applicable experience in reimbursement support relating to appeals and prior authorizations from a payer, provider or medical device/pharmaceutical industry required
• Must demonstrate the ability to draft professional and effective appeal letters
• Prior experience and knowledge of health insurance business, industry terminology, and regulatory guidelines
• Prior patient appeals experience is preferred
• Prior experience with Medicare, Medicaid, TRICARE, Workers Compensation and Commercial Insurance is preferred

Physical Demands :

• Required to sit; climb or balance; and stoop, kneel, crouch or crawl
• Required to regularly lift and/or move up to 10 pounds, and occasionally lift and/or move up to 25 pounds
• Required to possess specific visons abilities, including: close vision, distance vision, color vision, peripheral vision, depth perception and capacity to adjust focus

Our Values :

• Passionate About Innovation: Improving patient care by delivering advanced technology to our customers is at the core of what we do. We are passionate in our role in improving the lives of patients by continuously developing better solutions.
• Customer Focused: We listen to our customers' needs and respond with a sense of urgency.
• Teamwork: Working together, anything is possible. We value every person on our team and treat each other with respect. We are accountable to one another and support each other. Together, we make each other stronger.
• Driven: We pursue our mission with energy and passion. We are nimble, results-oriented and decisive. We overcome obstacles that arise in our quest to deliver solutions that will improve the lives of our customers and patients.

Equal Employment Opportunity :

Globus Medical is an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, age, disability, marital status, pregnancy, national origin or citizenship. We are committed to a diverse workforce. We value all employees' talents and support an environment that is inclusive and respectful.

Other Duties :

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.