Executive Lead

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🦌 Connecticut – Remote

🦌 Connecticut – Remote

⏰ Full Time

🟠 Senior

👔 Executive

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PRIA Healthcare

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2012

🏥 Healthcare

💼 Consulting

🤝 B2B

💰 Private equity on 2022-02

Healthcare • Consulting • B2B

PRIA Healthcare is a specialized consulting firm that helps medical device and healthcare technology companies navigate U. S. reimbursement, regulatory, and market access pathways to enable commercialization. PRIA offers strategic reimbursement solutions, health economics and outcomes research, evidence generation, payer and stakeholder engagement, patient access platforms and services (including reimbursement hotlines and clinical trial reimbursement), regulatory strategy and global marketing submissions, and quality management and post-market compliance support. The firm emphasizes tailored, pragmatic execution plans and states it has served 300+ clients, implemented 75+ patient access programs, and approved 40,000+ patients. PRIA is headquartered in Farmington, CT.

📋 Description

• Lead and manage a team of patient access specialists to achieve departmental goals • Monitor and analyze data within the salesforce platform to identify areas for improvement and efficiency • Responsible for teams KPIs • Train and mentor new patient access specialists • Audit a select number of cases per program as directed by the Director, Patient Access • Work closely with other Executive Leads and the Director, Patient Access to improve/enhance operations best practices • Maintain open communication with each program assigned Strategic Account Manager and work in conjunction with them on, weekly program reviews, calls, frequent questions or concerns regarding the program • Escalate issues to the program Strategic Account Managers as needed • Manage a case load for an assigned program • Data entry and review of new patient cases into system database • Communicate with physician’s office and their staff regularly • Maintain accurate and up-to-date records within the salesforce platform to ensure accurate reporting to clients • Complete full patient access process as outlined by program SOP including but not limited to: Analyze and interpret patient clinical data, clinical notes and files to determine medical necessity criteria is met specific to each payer policy • Review multiple insurance policies to define medical necessity criteria to support medical device/procedure(s) • Ensure compliance with all regulatory and company policies

🎯 Requirements

• College degree preferred but will substitute for applicable work experience • Minimum of 5 years of experience in healthcare authorization, with at least 2 years in a supervisory role • In-depth knowledge of insurance processes, medical terminology, and healthcare regulations • Strong leadership, analytical, and problem-solving skills • Excellent communication and interpersonal skills

🏖️ Benefits

• Health insurance • Paid time off • Professional development