Position Responsbilities:

• Provide ReActiv8 therapy education as it relates to setting expectations with patients and family members.
• Educate patients and families on the prior authorization and appeals process.
• Provide timely RSVP program authorization and appeals updates to physicians, their office staff, and patients.
• Review and evaluate supporting clinical evidence coordinating with physician’s offices when additional documentation is needed to support the appeals process.
• Work to ensure that each office’s specific process is running smoothly and efficiently, including timely notification of add-ons and cancellations, ensuring patients and clinical staff are aware of any potential insurance-related delays.
• Work in partnership with the Area Business Managers to facilitate weekly patient pipeline conference calls.
• Work with Therapy Manager team to determine a plan of action for each patient by documenting each plan of action under the patient’s opportunity in the internal system and tracking the progress or completion of each plan of action.
• Collaborate with field sales to ensure patient barriers are removed or addressed, and internal and external resources are aligned to facilitate the implant process.
• Upon approval, assists in referring the patient to the surgeon for consultation, including preparing the necessary paperwork.
• Actively build relationships with internal or external customers, setting realistic expectations.
• Manage multiple priorities and deadlines successfully, while handling stressful situations accordingly. Accepting risk and uncertainty.
• Ensure compliance with company compliance policy, in particular patient confidentiality (HIPAA) in all Mainstay Medical practices.
• Perform other duties as required.

Qualifications:

• Associate’s degree (heath economics, life sciences or public health) required. Bachelor’s degree strongly preferred.
• Minimum of 5 years of related LPN or RN experience with a Bachelor’s degree, or 3 years and a Master’s Degree.
• Travel expected approximately 2-3 times per quarter / 25% travel by car or airplane.
• Experience in care coordination, case management, and some knowledge of insurance.
• Experience in a medical office or hospital setting with coding and prior authorization experience.
• Knowledge of health insurance industry practices/functions to include Medicare, Medicaid, and all types of commercial and managed care organization’s coverage policies.
• Skilled at patient engagement and interaction; experience in patient education is a plus.
• Demonstrate excellent organizational skills with attention to detail.
• Clear written and verbal communication skills—both in-person and over the phone.
• Proficient in computer operations, including Microsoft Word, Outlook, Excel, PowerPoint, and basic database management.
• Problem solver and capable of finding solutions to challenges or process impediments.
• Maintains a caring, empathetic, and patient-centric approach in all interactions.

The salary range for this position is $86,000 to 116,000/year; however, base pay offered will take into account a range of 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.