Appeals Specialist (Medical Devices)

Location: Collegeville, Pennsylvania, United States

Company

hirify.global develops medical devices and patient access solutions, including Nevro’s HFX spinal cord stimulation platform for chronic pain treatment.

What you will do

• Manage patient access cases from prior authorization submission through the final appeals process.
• Develop professional, well-supported appeal letters based on payer policies and available clinical evidence.
• Review medical records and physician documentation for completeness and identify information required for appeals.
• Review payer approvals and denials, provide case-status updates, and communicate findings to field representatives and customer contacts.
• Monitor and resolve appeals and grievances in accordance with established policies and procedures.
• Report product complaints and maintain compliance with HIPAA, company policies, and applicable laws and regulations.

Requirements

• Bachelor’s degree in a related field.
• At least 2 years of reimbursement-support experience involving appeals and prior authorizations in a payer, provider, medical device, or pharmaceutical environment.
• Ability to draft professional and effective appeal letters.
• Knowledge of health insurance operations, industry terminology, and regulatory guidelines.
• Ability to meet defined performance metrics and timeliness standards.
• Ability to perform the stated physical requirements, including lifting up to 25 pounds occasionally.

Nice to have

• Prior patient appeals experience.
• Experience with Medicare, Medicaid, TRICARE, Workers’ Compensation, and commercial insurance.

Culture & Benefits

• Work is guided by innovation, customer focus, teamwork, and results-oriented execution.
• Commitment to patient care, ethical business practices, and socially responsible conduct.
• Inclusive workplace and equal employment opportunity for applicants and employees.
• Reasonable accommodations may be provided for individuals with disabilities.