San Diego candidates are preferred. Exceptional remote candidates will be considered.
Mainstay Medical
Mainstay Medical is a medical device company focused on marketing an innovative implantable neurostimulation system, ReActiv8®, for people with disabling chronic mechanical Low Back Pain. The company is headquartered in Dublin, Ireland, with subsidiaries operating in the United States, Australia, the United Kingdom, and Germany.
The Role
The Insurance Verification Specialist is responsible for the verification and coordination of patient benefits, pre-service review requirements, provider network status, and required CPT and HCPCS codes. This role supports internal and external customers regarding the Reactiv8® device and verifies patient eligibility for the Reactiv8® implant. Responsibilities include receiving and processing case documents, responding to inquiries from patients, payors, and field sales teams, and managing new customer profiles. The specialist is expected to deliver excellent service, possess strong communication skills, attention to detail, and a commitment to efficient, accurate customer support.
Position Responsibilities
- Verifies and organizes information related to Patient benefits, Pre-service review requirements, Provider network status, Required CPT (Current Procedural Terminology) and HCPC (Healthcare Common Procedure Coding System) codes.
- Assists in identifying payor policies within area of responsibility.
- Provides phone and email updates to Prior Authorization and Case Management as necessary.
- Maintains accurate records of patient benefit details within Cloud and web-based tools (i.e. Salesforce) as well as update internal and external customers.
- Collaborates with the Intake Coordinator in the receipt and processing of new and existing case documents from customers.
- Responds to inquiries from Payors, Field Teams and provide support via phone, e-mail and other communication channels.
- Owns and maintains payor fields within Salesforce.
- Delivers high-quality service by meeting or exceeding the needs of Customers, Patient Access teams, and Field Teams.
- Assists in preparing letters of medical necessity under the direction and supervision of the Case Management (CM) and Prior Authorization (PA) Team.
- Performs proactive follow up on the status of pre-service review cases on behalf of the Case Managers and Prior Authorization team members.
- Provides support with prior authorization and appeals submissions.
- Assists with training of Intake and new Verification Specialists while providing a supportive team environment.
- Maintains users and organization level detail regarding Payor portals.
- Demonstrated ability to work independently as well as part of a team that values collaboration and openness while balancing workloads to ensure patients are always prioritized.
- Performs departmental audits against SOPs, work instructions, work-flows and role based responsibilities to ensure high level of accuracy.
- Creates, updates and maintains SOPs, Work Instructions, and work-flows for Benefit Verification.
- Recommends and presents trends, areas of improvements and key successes.
- Communicates and recommends timely workloads across Patient Access Team members to ensure serve-levels are met or exceeded.
- Demonstrated ability to communicate well across multiple sources (in writing, in-person and online)
- Demonstrated ability to adapt to new technology quickly.
- Willingness to assist others in Commercial Operations with patients and/or special projects as requested from both inside and outside the department.
- Ensure compliance with company compliance policy, in particular patient confidentiality (HIPAA) in all Mainstay Medical practices.
Qualifications
- Typically requires an Associates degree or greater.
- One (1) to two (2) years of work experience performing data entry of patient information and/or Intake. Preferred experience: Life Science, medical device, Pharma, clinic, Hospital or related field.
- Demonstrated attention to detail, organizational skills, and data entry accuracy.
- Works well independently and as part of a team.
- Experience handling protected patient information (preferred).
- MS Office capabilities.
- Experience using Salesforce, MS Teams, Powerpoint, Sharepoint, and Visio (preferred).
- Ability to decipher and identify patterns and trends.
- Excellent verbal communication and interpersonal skills.
- Problem solver and capable to find solutions to challenges or process impediments.
- Experience using Cloud & Web-based tools.
- Ability to shift working hours dependent on regional workload.
The hourly range for this position is $24.81 to $31.53/hour however, the pay offered will consider various factors, including job-related knowledge, skills, and experience. The total compensation package includes a range of medical, dental, vision, financial, and other benefits, as well as equity.
Mainstay Medical is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to gender, race, color, religious creed, national origin, age, sexual orientation, gender identity, physical or mental disability, and/or protected veteran status. Mainstay Medical participates in E-Verify.