SetPoint Medical · 1 day ago
Market Access Specialist
United States
Full-time
Remote
Entry, Mid Level
$75K/yr - $100K/yr
2+ years expSetPoint Medical is a commercial-stage medical technology company dedicated to improving care for people living with chronic autoimmune diseases. The Market Access Specialist will facilitate patient access to support the launch of a neuroimmune modulation therapy for rheumatoid arthritis, managing pre-service clearance and prior authorization processes.
BiotechnologyHealth CareMedicalTherapeutics
No H1B
Responsibilities
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
Qualification
Required
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
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
Company
SetPoint Medical
SetPoint Medical provides a device-based therapy for rheumatoid arthritis.
51-200 employees
Funding
Current Stage
Late StageTotal Funding
$496.4MKey Investors
Sprig EquityRunway Growth CapitalNew Enterprise Associates
2025-08-11Series D· $115M
2025-08-11Series C· $25M
2025-03-27Series Unknown· $12.4M
Leadership Team
Rohan Seth
CFO
Recent News
2025-12-15
Company data provided by crunchbase