Job Description

The Prior Authorization Specialist is part of the Market Access & Reimbursement Team and serves as the primary liaison for providers, hospitals, and rehabilitation centers. The Prior Authorization Specialist will oversee the pre-service clearance process, including insurance verification, prior authorizations, and appeals management. The ideal candidate will bring a strong understanding of payer workflows and a commitment to delivering outstanding support to healthcare providers nationwide.

• Review insurance coverage policies related to vagus nerve stimulation (VNS) and stroke rehabilitation therapies.
• Contact insurance carriers to verify patient eligibility, benefits, and authorization requirements for Vivistim® Therapy.
• Request, collect, and manage patient medical records across multiple provider offices, ensuring HIPAA compliance.
• Submit and track prior authorization requests within defined timelines.
• Initiate and manage appeals for denied authorizations, including documentation and follow-up.
• Ensure accurate use of CPT, HCPCS, and ICD-10 codes throughout the process.
• Maintain thorough documentation of communications in internal databases and CRM systems.
• Identify trends or changes in payer policies and communicate updates to internal stakeholders.
• Provide support and resources to clinics to appeal denied services, including templates and procedural guidance.
• Respond to provider inquiries related to medical policy, claims status, and authorization processes.
• Apply knowledge of medical terminology and claims workflows to optimize reimbursement processes.
• Perform other duties as assigned to support the broader goals of the Market Access team.

Requirements

• Minimum of 2 years of experience in medical prior authorization, reimbursement, or medical front-office operations.
• Proven success navigating pre-service clearance and payer workflows.
• Experience working with medical records, insurance portals, and patient confidentiality regulations (HIPAA).
• Strong communication, documentation, and organizational skills.
• Ability to adapt in a fast-paced, team-oriented environment.
• Experience securing authorization for implantable medical devices, neuromodulation therapies, or rehabilitation services.
• Familiarity with hospital and physician billing processes for Medicare and commercial payers.
• Knowledge of the full revenue cycle, including claims submission, edits, and appeals.
• Proficiency in systems such as Salesforce®, EPIC®, or other EHR/ERP platforms.
• Coding certification (e.g., CPC) or practice management credentials (e.g., RHIA, RHIT).
• Experience working in a startup or growth-stage company.
• Background in neurostimulation or rehabilitation fields.

Benefits

MicroTransponder provides a comprehensive benefits program to employees. It includes medical, dental and vision plans along with an FSA. Employees may participate in the company 401(k) plan with company matching. The company offers an unlimited Paid Time Off (PTO) program and approximately 15 paid company holidays per year.

Job Tags

Similar Jobs