PRIAevents

Director

• Lead and support specific payer engagement initiatives, leveraging existing relationships to influence policy development and reimbursement strategies.
• Establish and strengthen relationships with key opinion leaders (KOLs) and influential stakeholders within payer organizations and the MedTech community.
• Analyze and present data-driven insights, identifying trends and ensuring payer engagement programs align with client goals.
• Collaborate with PRIA’s Market Access team to develop and communicate strategic plans, tactics, and payer engagement initiatives.
• Work cross-functionally with PRIA’s Reimbursement, Health Economics, and Market Access teams to ensure comprehensive strategy execution.
• Manage administrative tasks associated with overseeing a portfolio of clients.

Director of Payer Engagement

• Participation on weekly program calls as needed.
• Train and mentor new patient access specialists.
• Audit a select number of cases per program as directed by the Director/Manager, Patient Access.
• Manage a case load for an assigned program.
• Data entry and review of new patient cases into system database.
• Serve as a primary point of contact for providers and patients seeking insurance coverage assistance.
• Communicate with physician’s office and their staff regularly.
• Maintain accurate and up-to-date records within the salesforce platform to ensure accurate reporting to clients.
• Complete full patient access process as outlined by program SOP including but not limited to:
• Analyze and interpret patient clinical data, clinical notes and files to determine medical necessity criteria is met specific to each payer policy
• Review multiple insurance policies to define medical necessity criteria to support medical device/procedure(s)
• Conduct case-related research (e.g., payer coverage policies, self-funded plans, state and federal regulations).
• Benefits verification
• Prior Authoriation/ Pre- service review submissions, pre and post service appeal submissions
• Ensure all documents developed to support an appeal are accurate, consistent, up to date, and in compliance with applicable Standard Operating Procedures, guidelines, and regulations.
• Maintain strong professionalism, ethics, and compliance with all applicable laws and policies
• Ensure compliance with all regulatory and company policies.

Director of Payer Engagement

Patient Access Specialist – Director