SetPoint Medical’s Market Access Specialist will facilitate patient access to support the launch of the first neuroimmune modulation therapy to treat rheumatoid arthritis in the US. As the first non-pharmacologic treatment for rheumatic disease, this disruptive technology has the potential to improve the lives of people living with chronic autoimmune disorders.  

The Market Access Specialist is critical to ensuring patient access as a member of the market access and pre-service clearance function. With the support of an experienced management team, industry-leading IT infrastructure and a corporate culture built on flawless execution, the Market Access Specialist will have the opportunity to set a new standard in the medical device industry for what a Market Access program can be. The incumbent will manage pre-service clearance and prior authorization process for patients seeking access to SetPoint Therapy. This will include engagement with patients, rheumatology providers, neurosurgery practices and hospitals to ensure a smooth pre-service clearance process. This position will report to the Sr. Manager of Market Access.

• Execute the prior authorization/pre-service clearance process at SetPoint Medical.

• Review and log incoming medical record documentation, providing feedback to providers where necessary.

• Submit prior authorizations and appeals to drive timely approval for every qualified candidate.

• Establish strong relationships with referring rheumatology practices, neurosurgery providers, hospitals and health systems to deliver best-in-class prior authorization services.

• Identify payer behaviors, actions and trends that inform prior authorization approach.

• Complete corporate administrative and training requirements on time and accurately.

• Maintain company standards involving ethical and moral character, and always represent the company with the highest professional standards.

Minimum Qualifications

• At least 2 years’ experience working in prior authorization and/or pre-service clearance function at a medical device/pharmaceutical company, healthcare provider, or third-party market access service provider.

• Experience with prior authorization for surgical procedures.

• Understanding of medical practice management, specifically related to prior authorization portals, NPIs, electronic health records and patient/provider releases.

• Awareness of, or ability to quickly learn, the medical policy and coverage landscape for vagus nerve stimulation.

• Knowledge of the prior authorization appeal processes that include external review, state fair hearing, ALJ.

• Awareness of State and Federal laws that impact patient and provider appeal rights, external review protocols and URAC standards.

• Experience with HIPAA compliance standards for covered entities.

• Understanding of Prior Authorization workflows and ability to learn and use IT systems such as Salesforce, EPIC, Cerner, etc.

Preferred Qualifications

• Successfully build relationships with healthcare providers and practice managers (specialties, surgeons).

• Ability to work independently and manage the various prior authorization systems and processes for patients and providers.

• Manage complexity and re-prioritize work efforts to drive efficiency and outcomes.

• Ability to understand trends, identify issues and develop corrective actions.

• Ability to thrive in a fast-paced, dynamic startup environment, with a willingness to adapt to changing priorities and market conditions.

• Passion for improving patient outcomes and a commitment to the company's mission and values.

Physical Requirements

• Ability to perform routine physical tasks, including lifting to 20 pounds.

• Prolonged periods of sitting at a desk and working on a computer.

Work Location and Travel

• This position is remote but will require occasional travel up to 10%, including travel to Company Headquarters in Valencia CA.

Company Description

SetPoint Medical is a commercial-stage medical technology company dedicated to improving care for people living with chronic autoimmune diseases.

Department: Marketing
Reports To: Sr. Manager Market Access
FLSA Status:  Exempt  
Location: Remote 

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire. Candidates must have and maintain authorization to work within the United States as a condition of employment.

We are proud to be an equal opportunity employer and we value diversity. SetPoint does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need.