Job Title: Sr. Patient Case Advocate
Travel: Occasional 10% travel including team meetings, regional sales meetings and reimbursement educational events
General Responsibilities: - Acts as single point of contact and voice for regional providers, patients, and the sales team.
- Investigate peer coverage policies related to SI Joint fusion.
- Ensure patient medical documentation supports the highest opportunity for a successful pre-authorization or appeal.
- Coordinates access to iFuse, conducts appropriate follow-up and facilitates access to surgery.
- Must at all times act and conduct company business in an honest, ethical and strictly legal manner, complying with the Code of Conduct, other company policies, the AdvaMed Code and all applicable laws and regulations, whether national, regional, state or local.
- Responsible for performing all duties in compliance with all applicable worldwide regulatory requirements as included in the scope of the SI-BONE Quality Manual.
Specific Responsibilities and Skills:- Serves as a patient advocate to help patients navigate the reimbursement process to obtain access to minimally invasive SI Joint fusion surgery with iFuse implants.
- Partner with Area Reimbursement Manager on case authorization and appeal strategies.
- Provide effective collaboration as the liaison between the patient, surgeons/surgeons' offices and payor to coordinate attempt to secure coverage for iFuse system implantation.
- Ensure high quality customer service and frequent interaction with surgeon offices and patients regarding case status and outcome of pre-authorizations and appeals in company's case management program.
- Aid physician office staff and patients to complete and submit all necessary insurance forms and program applications in a timely manner.
- Provide exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
- Process any correspondence; ensure accurate and thorough case documentation in database.
- Coordinate securing patients supporting medical documentation, letters of medical necessity and appeal letter signatures from referring surgeons.
- Provide Territory Manager or other sales management personnel with case updates, as needed.
- Track, monitor and report the outcomes of reimbursement initiatives (example: appeal outcomes from peer - peer reviews, external [independent] medical reviews, trends, observed from the various initiatives, etc. in assigned territory.
- Support the SI-BONE Quality System.
Knowledge, Education and Experience:- Bachelor's Degree preferred.
- Medical device experience a plus.
- Certified professional coder preferred.
- 10+ years' experience with health insurance benefits investigations, and reimbursement along with billing and coding.
- Experience supporting appeals for experimental and investigational procedures.
Expertise & Attributes:- Excellent written and verbal communication skills.
- Assist patients with understanding what they need, listen and communicate with insurance providers, doctors, nurses and specialists, and relay this information back to their clients.
- Excellent customer service skills with a focus on assisting patients in a healthcare environment.
- Strong attention to detail, time management and organizational skills.
- Demonstrates a positive 'can do' attitude
- Possess a demonstrated ability to communicate effectively and work well with others throughout the Company.
- Possess effective problem-solving skills.
- Be known as a person who has high integrity, sound character, a tremendous work ethic and the passion to succeed.
- Knowledge and familiarity of applicable regulations/standards (e.g. ISO 13485, FDA 21 CFR 820, EU MDR 2017/745, ISO 14971) as required to perform the job function.
Salary range: $76,000-$86,000. The compensation range for this position is specific to the location and is in good faith what SI-BONE expects to pay for the position taking into account the wide variety of factors that are considered in making compensation decisions, including job-related knowledge; skillset; experience, education and training; certifications; and other relevant business and organizational factors.
Supplemental pay: bonus and stock
There are potential risks associated with the iFuse Implant System. It may not be appropriate for all patients and all patients may not benefit. For additional information on the company or the products including risks and benefits, please visit www.si-bone.com/risks.
