Prior Authorization Specialist

• Provide expertise in prior authorization and implement the Inspire Prior Authorization Program in the United States
• Work with Territory Managers and the prior authorization team to answer coding and coverage questions
• Enter and manage patient information in databases
• Assist with patient intake and verify insurance coverage
• Call insurance providers to obtain prior authorization request status
• Work with patients and sites to pursue authorization success
• Track and monitor prior authorization requests and related appeals through External Medical Review (EMR)
• Update materials and best practices supporting prior authorization and appeals processes
• Seek continuous process improvement to increase success rates and reduce time to success
• Train sites on program requirements
• Complete prior authorization requests
• Provide guidance to sites on appeals, including EMR
• Work directly with patients to pursue EMR success
• Provide general coding information to physician customers
• Execute action plans and objectives with managers and staff to support internal/external clients
• Document product and therapy-related field reports and provide follow-up reporting
• Complete required training and competency confirmations
• Comply with quality system procedures and policies

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