Prior Authorization Specialist
About the job
- At least 2 years of related work experience in reimbursement.
- Demonstrated knowledge of reimbursement compliance requirements and ability to promote a compliant reimbursement environment with personal integrity.
- Ability to read, interpret, and appropriately respond to payer requirements relating to prior authorization.
- Ability to read, interpret, and summarize clinical and cost literature.
- Proficiency in Microsoft Office applications, including Word, PowerPoint, and Excel.
- Bachelor’s degree preferred.
- Medical device experience preferred.
- Support the Prior Authorization Program by entering and managing patient information in a database, assisting with patient intake and insurance coverage verification, calling insurers to obtain the status of prior authorization requests, and working with patients and sites to pursue authorization success.
- Track and monitor prior authorization requests and related appeals through to External Medical Review (EMR).
- Participate in updating materials and best-practice methods supporting prior authorization and appeals processes, including EMR for upper airway stimulation.
- Seek continuous process improvement to increase success rates and reduce time to success.
- Implement the Prior Authorization Program by training sites on program requirements, completing prior authorization requests, providing participating sites guidance on all levels of appeals including EMR, and working directly with patients to pursue EMR success.
- Provide general coding information to physician customers upon request.
- Work with the manager and staff to execute action plans and objectives supporting internal and external clients.
- Document product- and therapy-related field reports within prescribed timelines, provide documents needed to complete investigations, and submit follow-up reports as needed.
- Complete required training and competency confirmations within required timelines.
- Comply with applicable quality system procedures and policies, and suggest continuous process improvements.
- Medical device experience.
About the company
Inspire Medical Systems develops and sells a minimally invasive implantable device for obstructive sleep apnea (OSA). Its lead product, the Inspire system, uses implanted neurostimulation to activate the hypoglossal nerve, which moves the tongue and other airway muscles to keep the airway open during sleep. Patients control the therapy with a small handheld remote. The system targets adults with moderate to severe OSA who cannot use or benefit consistently from CPAP. Unlike non-implant options, Inspire provides a hands-free, on-demand airway support during sleep and is the first FDA-approved neurostimulation treatment for OSA. The company differentiates itself by offering a clinically approved implantable alternative to CPAP, backed by a direct US sales force and a network in Europe. Its goal is to provide an effective, durable option for patients who struggle with CPAP, expanding access to neurostimulation therapy to improve sleep quality and health outcomes.
Company Size
1,001-5,000
Company Stage
IPO
Headquarters
Golden Valley, Minnesota
Founded
2007
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Simplify's Take
What believers are saying
- August 2026 Project Horizon targets $30 million annualized investment capacity by 2027.
- September 2026 conference materials said coding clarity improved and WISeR-state billing issues eased.
- CMS proposed 2027 facility-rate increases of 12% to 15%, supporting procedure economics.
What critics are saying
- The January 2026 class action alleges Inspire V launch failures and misleading disclosures.
- Medicare coding disruption cut second-quarter revenue $40 million; management expects $120 million-$130 million full-year impact.
- If reimbursement stalls again before 2028 CPT approval, Inspire's growth thesis breaks quickly.
What makes Inspire Medical Systems unique
- Inspire remains the only FDA-approved hypoglossal nerve stimulator for moderate-to-severe OSA.
- The 2026 launch of Inspire V strengthened procedure simplicity and 3.0T MRI compatibility.
- Direct U.S. sales and distributor coverage give Inspire tight control over adoption and education.
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Benefits
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Disability Insurance
- Health Savings Account/Flexible Spending Account
- 401(k) Retirement Plan
- 401(k) Company Match
- Unlimited Paid Time Off
- Tuition Reimbursement
- Employee Assistance program
- Employee Stock Purchase Plan