Prior Authorization Specialist

Inspire is the first of its kind medical device designed to make a difference in the lives of those living with Obstructive Sleep Apnea (OSA). We are revolutionizing the sleep industry with our FDA-approved medical device, designed to reduce OSA severity for those who cannot tolerate or get consistent benefit from CPAP. Inspire Medical Systems is committed to enhancing patients’ lives through sleep innovation.

We are steadfast in our commitment to prioritize patient outcomes, act with integrity and lead with respect. With positive persistence at our core, we are committed to all those we serve.

At Inspire, we value people – your diverse experiences, backgrounds, and thoughts. We elevate voices and encourage learning opportunities to build a professional network that grows into community. We embrace a people-first culture by offering excellent benefits, 401k matching, ESPP, flexible time off (FTO), and tuition reimbursement. If you’re passionate about making a difference in people’s lives and want to work with innovative technology, come be a part of our great team!

• Fully Remote Position*

We are recruiting for a Prior Authorization Specialist to join our team. In this role, you will be providing expertise in the area of prior authorization and will be responsible for implementing the Inspire Prior Authorization Program in the United States. You will be working with the Territory Managers and the prior authorization team to ensure all coding and coverage questions are answered correctly and concisely.

• Support Inspire’s Prior Authorization Program, including:
• Entering and managing patient information in database
• Assisting with patient intake and verifying of insurance coverage
• Calling insurances to obtain the status of Prior authorization requests
• Working with patients and sites to pursue authorization success.
• Assist in tracking and monitoring progress of prior authorization requests, along with all related appeals through to EMR.
• Participate in updating the packet of materials and best practices methods to support the prior authorization and appeals processes, including External Medical Review, (EMR) for upper airway stimulation.
• Seek continuous process improvement to increase success rates and reduce time to success.
• Implement Inspire’s Prior Authorization Program, including:
• Training sites on program requirements
• Entering and managing patient information in database
• Completing prior authorization requests
• Providing guidance to participating sites on all levels of appeals including EMR
• Working directly with the patient to pursue EMR success.
• Provide general coding information to physician customers upon request.
• Work in conjunction with manager and staff to execute action plans and objectives to support internal/external clients.

• Document product and therapy related field reports within the prescribed timelines and provide any necessary documents required to complete the investigation. Provide follow-up reporting as needed.
• Complete training requirements and competency confirmations as required for this position within the required timeline.
• Comply with applicable quality system procedures/policies and make suggestions for continuous process improvement.

• 2+ years of related work experience in reimbursement
• Demonstrated knowledge of reimbursement compliance requirements and a maintaining a high level of personal integrity to promote a compliant reimbursement environment
• Ability to read, interpret and appropriately respond to payer requirements relating to prior authorization
• Ability to read, interpret and summarize…