Therapy Access Specialist

About this Position

Cala Health’s Therapy Access Specialist is the main point of contact for new patients throughout the sales process to obtain Cala Health products and services. Responsibilities include, but are not limited to, contacting patient and healthcare providers for documentation, verifying insurance benefits and securing authorizations. This role requires specific knowledge of health insurance plans, interpretation of benefits and prior authorization protocol. General knowledge of durable medical equipment (DME) coverage landscape is strongly recommended. The Therapy Access Specialist reports to the Associate Director, Therapy Access and has no direct reports.

 Specific Responsibilities

• Guide new patients through the sales and healthcare reimbursement process
• Develop and maintain superior knowledge of company products and their use
• Educate potential patients about benefits and features of Cala Health devices and its therapy
• Partner with assigned field sales representatives to coordinate the sales process to support the shipment process
• Contact with physicians and clinicians to collect medical documentation to identify medical necessity requirements
• Investigate patient’s insurance benefits and coverage eligibility
• Review patient clinical records to determine medical necessity eligibility
• Identify provider restrictions, co-pays, deductibles, and other patient cost share responsibilities; communicate outcomes and collect payments
• Secure document requirements for prior authorization and seek authorizations when required
• Take inbound calls from new patients to provide information about status of order
• Work with Veteran Administration facilities to promote and process Cala Health devices and therapy
• Update and maintain database platforms for sales order processing and claim submission preparation
• Document all interactions and calls into the customer relationship management (CRM) system in accordance with Quality Assurance, Regulatory and HIPAA guidelines
• Support company goals and objectives, policies and procedures, Good Manufacturing Practices, and FDA regulations
• Additional duties as assigned
• Shift times may vary based on business needs

Skills and Experience

• Bachelor’s degree is strongly preferred; High school diploma or equivalent required
• 3-5 years of medical insurance experience, preferably at a medical device company
• Knowledge of managed care industry including government payers
• Understanding of healthcare plans and benefits related to durable medical equipment
• Ability to build and maintain strong relationships with cross-functional teams and external partners
• Proficient in aspects of reimbursement and revenue cycle management
• Ability to work collaboratively in a team structure and responsibly delegate next steps to appropriate team members
• Demonstrates effective problem-solving abilities, attention to detail and ability to prioritize
• Ability to travel as required for training
• Proficiency in Microsoft Word and Excel.
• Experience using Salesforce is preferred but not required

Physical Demands

• While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach and use hands and fingers to operate a computer, telephone and keyboard
• Specific vision abilities required by this job include close vision requirements due to computer work
• Ability to sit or stand at a desk for extended periods of time