Market Access Specialist, I – II

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $75k - $100k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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SetPoint Medical

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏭 Manufacturing

🏥 Healthcare

🧬 Biotechnology

Manufacturing • Healthcare • Biotechnology

SetPoint Medical is a privately held clinical-stage healthcare company dedicated to treating patients with autoimmune diseases. The company is developing a novel platform designed to stimulate the vagus nerve to activate innate anti-inflammatory pathways to produce a systemic immune-restorative effect. SetPoint Medical’s platform technology is designed to offer patients and providers a treatment alternative for rheumatoid arthritis, inflammatory bowel disease, and other chronic autoimmune conditions with potentially less risk and cost than drug therapy.

📋 Description

• 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

🏖️ Benefits

• Fully remote work arrangement • Occasional travel up to 10%, including travel to Company Headquarters in Valencia, CA • Equal opportunity employer and commitment to diversity