Director, Prior Authorization

ABOUT INSPIRE MEDICAL SYSTEMS

Inspire is the first of its kind medical device designed to make a difference in the lives of those living with Obstructive Sleep Apnea (OSA). We are revolutionizing the sleep industry with our FDA-approved medical device, designed to reduce OSA severity for those who cannot tolerate or get consistent benefit from CPAP. Inspire Medical Systems is committed to enhancing patients' lives through sleep innovation. We are steadfast in our commitment to prioritize patient outcomes, act with integrity and lead with respect. With positive persistence at our core, we are committed to all those we serve.

WHY JOIN OUR FAST-GROWING TEAM

At Inspire, we value people - your diverse experiences, backgrounds, and thoughts. We elevate voices and encourage learning opportunities to build a professional network that grows into community. We embrace a people-first culture by offering hybrid work schedules, excellent benefits, 401k matching, ESPP, flexible time off (FTO), and tuition reimbursement.

If you're passionate about making a difference in people's lives and want to work with innovative technology, come be a part of our great team!

ESSENTIAL JOB FUNCTIONS

The Director of Prior Authorization is responsible for leading and overseeing the prior authorization and appeals teams for Inspire. This role ensures that patients, healthcare providers, and insurance companies navigate the authorization and reimbursement process effectively. The Director will collaborate with market access reimbursement, payer account, regulatory, compliance, and sales teams to streamline the authorization process, ensuring timely and accurate approvals for Inspire's medical device(s) while maintaining compliance with healthcare regulations. The Director will, in addition to the leadership of the team, work in close collaboration with the VP of Market Access and other internal stakeholders to develop and implement special projects that pertain to prior authorization.

OPPORTUNITIES YOU WILL HAVE IN THIS ROLE

Leadership and Management:

• Lead a team of prior authorization and appeals specialists (26), including two supervisors.
• Develop and communicate a clear vision and strategic goals for the team, ensuring alignment with the objectives for the Market Access Team
• Develop and implement strategies for improving the efficiency and effectiveness of prior authorization/appeals processes.
• Ensure the team is well-trained in understanding payer policies, healthcare regulations, and the unique needs of medical device reimbursement.
• Provide strong leadership and development, fostering a culture of continuous learning and professional growth

Prior Authorization Process:

• Oversee the end-to-end prior authorization process, including the submission of required documentation, follow-up, and appeals.
• Analyze and optimize authorization workflows to minimize delays and improve approval rates.
• Work directly with healthcare providers, payers, and patients to resolve issues related to prior authorization.

Regulatory Compliance:

1. Stay current on regulatory requirements related to medical device prior authorization, including Medicare, Medicaid, and private payer policies.
2. Ensure compliance with applicable laws, rules, and regulations governing reimbursement for medical devices.
3. Oversee audits and assessments to ensure adherence to authorization and reimbursement standards.

Collaboration and Communication:

1. Collaborate with cross-functional teams such as sales, clinical affairs, customer support, and legal to address complex issues.
2. Develop strong working relationships with payer representatives, medical professionals, and internal departments.
3. Provide ongoing education to the internal team and external partners on changes in reimbursement guidelines and authorization protocols.

Reporting and Analytics:

1. Analyze trends and data related to prior authorization denials and approvals, providing actionable insights for process improvement.
2. Prepare regular reports on authorization success rates, denials, and reasons for appeals.
3. Develop and present strategies to increase authorization approval rates and optimize financial outcomes.

Strategic Initiatives:

1. Contribute to the development of strategies for new product launches.
2. Advocate for policy changes or payer negotiations to streamline the reimbursement process where needed.
3. Document product and therapy related field reports within the prescribed timelines and provide any necessary documents required to complete the investigation. Provide follow-up reporting as needed.
4. Complete training requirements and competency confirmations as required for this position within the required timeline.
5. Comply with applicable quality system procedures/policies and make suggestions for continuous process improvement.

WHAT YOU CAN BRING TO OUR GREAT TEAM

Required:

Bachelor's degree in Healthcare Administration, Business Administration, or a related field. Advanced degrees (Master's, JD, etc.) are a plus.

• Minimum of 7-10 years of experience in prior authorization, reimbursement, with in the medical device industry.
• At least 5 years in a leadership role overseeing prior authorization teams.
• Experience working with payer policies, insurance companies, and government health programs (Medicare, Medicaid).
• Knowledge of medical device regulations, coding, and billing (e.g., ICD-10, HCPCS, CPT).

• Strong understanding of medical device reimbursement processes and the payer landscape.
• Excellent communication, negotiation, and problem-solving skills.
• Ability to lead teams, manage complex processes, and collaborate with stakeholders at all levels.
• Proficiency with healthcare software and prior authorization systems.
• Analytical mindset with the ability to interpret data and provide actionable insights.
• Lead and manage change initiatives from conception through implementation

• This role is remote work but may require some travel to meet with stakeholders internally and or attend industry events.

SALARY

The salary for this position is expected to be between ($180,500 - $270,700) and will be offered at a level consistent with the experience and qualifications of the candidate. This information reflects the anticipated salary range for this position at the time of posting. The salary range may be modified in the future and actual compensation may vary from the posting based on various factors such as geographic location, work experience, education and/or skill level.

BENEFITS AND OTHER COMPENSATION

Inspire offers a highly competitive benefits package including (general description of the benefits and other compensation offered):

• Multiple health insurance plan options.
• Employer contributions to Health Savings Account.
• Dental, Vision, Life and Disability benefits.
• 401k plan + employer match.
• Identity Protection.
• Flexible time off.
• Tuition Reimbursement.
• Employee Assistance program.
• All employees have the opportunity to participate in the ownership and success of Inspire. Employees at all levels can participate through equity awards and the Employee Stock Purchase Program.

Inspire Medical Systems provides equal employment opportunity (EEO) to all employees and applicants without regard to race, color, religion, creed, sex, national origin, age, disability, marital status, familial status, sexual orientation, status regarding public assistance, membership or activity in a local commission, military or veteran status, genetic information, pregnancy or childbirth, or any other status protected by applicable federal, state, and local laws. This policy applies to all aspects of the employment relationship, including recruitment, hiring, compensation, promotion, transfer, disciplinary action, layoff, return from layoff, training, and social and recreational programs. Inspire Medical Systems complies with applicable laws governing non-discrimination in employment in every location in which Inspire Medical Systems has facilities. All such employment decisions will be made without unlawfully discriminating on any prohibited basis.

Inspire Medical Systems is anequal opportunityemployer with recruitment efforts focused on ensuring a diverse workforce.Applicants with a disability that need accommodation to complete the Inspire Medical Systems application process should contact Human Resources at 844-672-4357 or email careers@inspiresleep(dot)com

Inspire Medical Systems participates in E-Verify.