Requisition ID: 6213
Job Title: Patient Access Specialist (Remote)
Job Country: United States (US)
Here at Avanos Medical, we passionately believe in three things:
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Making a difference in our products, services and offers, never ceasing to fight for groundbreaking solutions in everything we do;
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Making a difference in how we work and collaborate, constantly nurturing our nimble culture of innovation;
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Having an impact on the healthcare challenges we all face, and the lives of people and communities around the world.
At Avanos you will find an environment that strives to be independent and different, one that supports and inspires you to excel and to help change what medical devices can deliver, now and in the future.
The Avanos COVID-19 Vaccine Policy: This Policy applies to U.S. customer-facing / field-based employees & Avanos leadership: All U.S. customer-facing / field-based employees hires must be fully vaccinated against COVID-19. Proof of being fully vaccinated does not need to be disclosed until a job offer has been made but must be submitted within 48 hours after the acceptance of the job offer. If you have a qualifying medical condition or sincerely held religious belief or practice that precludes you from receiving a COVID-19 vaccine, you may apply for an exemption or deferral after you accept the job offer and before your scheduled start date. The reasonable accommodation provided to the employee, if any, will depend on the employee’s job and the applicable facts, but it may include weekly COVID-19 testing and masking requirements. New hires who do not submit, before their scheduled start date, proof of being fully vaccinated or a request for a reasonable accommodation will have their job offer revoked.
Avanos is a medical device company focused on delivering clinically superior breakthrough solutions that will help patients get back to the things that matter. We are committed to creating the next generation of innovative healthcare solutions which will address our most important healthcare needs, such as reducing the use of opioids while helping patients move from surgery to recovery. Headquartered in Alpharetta, Georgia, we develop, manufacture and market recognized brands in more than 90 countries. Avanos Medical is traded on the New York Stock Exchange under the ticker symbol AVNS. For more information, visit www.avanos.com.
Summary
The Patient Access Specialist is part of the Market Access, Reimbursement, and Medical Policy (MA&R) team. The MA&R team supports internal and external customers navigate through reimbursement nuances and barriers, the facilitation of authorizations and appeals, and collaborates with key opinion leaders, Specialty Societies, Government organizations, and payer decision makers to influence coverage via policy change in efforts to increase access to Avanos products. This role will primarily focus on the Avanos Pain Management and Recovery product portfolios, radiofrequency ablation products.
The Patient Access Specialist will provide exceptional support to internal and external customers, collaborate with payers, providers, patients, field sales representatives, verify patient eligibility for appeals, collect supportive clinical documentation to fulfill payer requirements for the facilitation of authorizations and/or appeals, and process decisions from payers.
Primary Responsibilities/expectations
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Executes verification of patient eligibility for appeals, collection of supportive clinical documentation for the facilitation of authorizations and/or appeals fulfilling payer requirements to enable access to treatment, and processing decisions from payers.
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Provides expert-level acumen and superior support on the prior-authorization and appeal processes for commercial insurance companies, government payers, workers compensation, and liability insurances to internal and external customers and patient candidates in an accurate, consistent, timely, and compliant manner.
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Coordinates with providers and patients to obtain appropriate authorizations and necessary documentation for the facilitation of member-based appeals via the patient access program and provides frequent and on-going communications to providers, patients, payers, and internal teams as applicable while maintaining precise documentation in all applicable internal databases and files.
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Provides tactical direction to internal and external customers based on existing prior-authorization and appeal guidelines and policies.
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Assists in the monitoring of applicable patient access changes and/or trends that may impact access to Avanos Medical’s products. Sharing of observations with Manager to aide in the identification of potential opportunities to improve access and neutralize barriers to Avanos’ products.
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Recognizes customer and program needs and opportunities. Assist in the development and preparation for patient access program and educational materials.
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Accurately interprets payer determinations, understands the correlation of the determinations to payer coverage policies to ensure facilitation of an effective appeal.
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Establishes professional relationships and maintains an effective communication network with the internal and external customer.
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Consistently demonstrates uncompromised ethics while helping others understand legal and regulatory parameters related to patient access.
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Adheres to Standard Operating Procedures, Corporate Compliance programs, and successfully participates in training and continuing education programs.
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Performs work in a compliant manor in accordance with requirements applicable to patient access support in medical device environments; including but not limited to HIPAA, HITECH, and ADVAMED.
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Performs other duties and projects as assigned by management.
qualifications / education / experience
Required Qualifications:
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Minimum of 2 years’ relevant experience in health insurance authorizations and appeals for various plan types including Medicare, Medicare Advantage, Medicaid, Managed Medicaid, Commercial, Workers Compensation, and Liability.
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Knowledge of patient access, medical benefits, insurance authorization and appeal standards, payer coverage policies, and compliance requirements for various plan types in the government and private payer landscapes.
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Experience in authorizations and appeals specific to surgical proceure(s), and/or medical device(s), and/or DME, and/or biologic(s).
- Comprehensive understanding of medical benefits and pre-/post-service authorization and appeals processes for coverage and payment for government and private payers.
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Collaborative work ethic with excellent project and time management as well as exceptional written and verbal communication skills.
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Proficient in using Microsoft PowerPoint, Excel, Windows, and Microsoft Office. Experience with data visualization software (e.g., Tableau) and CRM applications (e.g., Salesforce.com) or aptitude to learn such tools. General ability to learn and acclimate to new systems.
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Working knowledge of compliance and regulatory medical device environments; including but not limited to HIPAA, HITECH, ADVAMED, and Federal Statutes around reimbursement.
job position scope
Travel – less than 10%
Salary Range:
The anticipated average base pay range for this position is $72,084 - $108,016. In specific locations, the pay range may vary from the base posted.
Avanos Medical is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, gender identity or any other characteristic protected by law. If you are a current employee of Avanos, please apply here .
Join us at Avanos
Join us and you can make a difference in our products, solutions and our culture. Most of all, you can make a difference in the lives, people, and communities around the world.
Make your career count
Our commitment to improving the health and wellbeing of others begins with our employees – through a comprehensive and competitive range of benefits. We provide more than just a salary – our Total Rewards package encompasses everything you receive as an employee; your pay, health care benefits, retirement plans and work/life benefits.
Avanos offers a generous 401(k) employer match of 100% of each pretax dollar you contribute on the first 4% and 50% of the next 2% of pay contributed with immediate vesting.
free onsite gym | benefits on day 1 | HQ region voted ‘best place to live’ by USA Today
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