Patient Access Specialist - SF Bay area or remote based

Nevro (NYSE: NVRO) is a global medical device company headquartered in Redwood City, California. We are focused on delivering comprehensive, life-changing solutions that continue to set the standard for enduring patient outcomes in chronic pain treatment. The company started with a simple mission to help more patients suffering from debilitating pain and developed its proprietary 10 kHz Therapy™, an evidence-based, non-pharmacologic innovation that has impacted the lives of more than 100,000 patients globally.

Nevro’s comprehensive HFX™ spinal cord stimulation (SCS) platform includes a Senza SCS system and support services for the treatment of chronic trunk and limb pain and painful diabetic neuropathy. Senza®, Senza II®, Senza Omnia™, and Senza HFX iQ™ are the only SCS systems that deliver Nevro's proprietary 10 kHz Therapy. HFX iQ, Nevro’s latest innovation, is the first and only SCS System that uses Artificial Intelligence to optimize and maintain pain relief using each patient's response1.Nevro’s unique support services provide every patient with an HFX Coach™ throughout their pain relief journey and every physician with HFX Cloud™ insights for enhanced patient and practice management.

Reporting to the Supervisor, Patient Access, the Patient Access Specialist will focus on providing payer coverage support to customers from the initial processing of received documentation through prior authorization, appeals support, detailed claims review, and hotline support. The Patient Access Specialist will be responsible for providing payer coverage expertise and support regarding all phases of the prior authorization process, appeals, and all related patient access activities with all types of customers. The Patient Access Specialist will be responsible for providing excellent customer service and follow-up on all assigned work. The Specialist will also be responsible for meeting required metrics to ensure quality service to all customer types.

• 
  The Patient Access Specialist will adhere to quality of HFX Access service through QA, additional training, and process improvement.
• Work in conjunction with the Supervisor to focus on realistic and achievable turn-around times for all department functions.
• Review documentation provided by physicians for completeness and can recognize information that is missing that is necessary for completing a case
• Meet and/or exceed metrics in designated region to ensure quality service to all customer types.
• Provide necessary documentation and follow up to support the prior authorization and appeal process as well as provide education to customers regarding payer coverage requirements.
• In conjunction with other team members, stay current on payer coverage policies and patient requirements for HF10 therapy as well as stay current on impact of health care reform to patient’s access to HF10 therapy.
• Ensure compliance with company compliance policy, in particular patient confidentiality (HIPAA) in all HFX Access practices.
• Perform other duties as required

• Bachelor’s Degree (health economics, life sciences, public health, public policy, finance, business or marketing disciplines) or equivalent work experience.
• 1-2 years of customer service, patient access, or prior authorization experience.

• Experience complying with regulatory requirements and company policy in dealing with the customer and patient confidentiality.
• Applicable experience in customer service and/or reimbursement support relating to appeals and prior authorizations from a payer, provider, or medical device/pharmaceutical industry.
• Ability to work with various teams to accomplish organizational goals.
• Excellent communication skills, both verbal and written.
• Analytically focused with a high attention to detail.
• Ability to follow work processes.
• Must be courteous, professional, and balanced with a tenacious drive-in order to assist the customer and HFX Access team in achieving goals.
• Able to multitask and prioritize workflows.
• Excellent organizational and project management skills.
• Strong interpersonal skills to influence/negotiate complex decisions and ability to demonstrate leadership as a positive advocate for communicating the mission, objectives, and results of the HFX Access team and build cross-functional relationships.
• Working knowledge of medical terminology
• Knowledge of HCPCS Coding
• Knowledge of ICD-10 coding