Job Details

This role is a remote role. The employee may reside anywhere in the United States.

The Patient Access Senior Specialist serves as a senior reimbursement expert responsible for managing the most complex insurance cases related to coverage of the Leva Pelvic Health System.

This role focuses on advanced appeals, payer escalation strategies, and Independent Review Organization (IRO) submissions. The Senior Specialist is responsible for ensuring that cases move through the authorization and appeals process efficiently while applying advanced strategic approaches that maximize the probability of payer approval.

In addition to handling complex cases, this role contributes to the development of best practices for payer engagement, appeal strategies, and authorization workflows that support improved patient access to innovative therapies.

Responsibilities Include:

• Manage complex authorization cases requiring advanced payer escalation strategies
• Ensure cases move through authorization and appeal workflows with urgency while maintaining strong submission quality
• Draft and submit multi-level appeals and IRO submissions
• Analyze payer policies, denial rationales, and documentation requirements to develop strategic appeal arguments
• Communicate with payer escalation teams, medical directors, and review organizations when necessary
• Serve as a subject-matter expert and mentor for Patient Access Specialists and Associates
• Identify patterns in payer behavior and develop strategies that improve approval outcomes
• Maintain detailed case documentation within Salesforce CRM
• Assist with development of authorization and appeal templates that strengthen submissions
• Collaborate with Market Access leadership to identify coverage expansion opportunities
• Maintain compliance with HIPAA and regulatory requirements

Qualifications Needed:

• Manage complex authorization cases requiring advanced payer escalation strategies
• Ensure cases move through authorization and appeal workflows with urgency while maintaining strong submission quality
• Draft and submit multi-level appeals and IRO submissions
• Analyze payer policies, denial rationales, and documentation requirements to develop strategic appeal arguments
• Communicate with payer escalation teams, medical directors, and review organizations when necessary
• Serve as a subject-matter expert and mentor for Patient Access Specialists and Associates
• Identify patterns in payer behavior and develop strategies that improve approval outcomes
• Maintain detailed case documentation within Salesforce CRM
• Assist with development of authorization and appeal templates that strengthen submissions
• Collaborate with Market Access leadership to identify coverage expansion opportunities
• Maintain compliance with HIPAA and regulatory requirements
• Ability to work independently while contributing to a team-based environment

Equal Employment Opportunity Statement:

Axena Health is an equal opportunity employer committed to building a diverse and inclusive workplace. We make employment decisions based on qualifications, merit, and business needs, and do not discriminate on the basis of race, color, religion, sex, gender identity or expression, sexual orientation, national origin, age, disability, veteran status, genetic information, or any other protected status under applicable law.

We believe that diverse perspectives drive innovation and better outcomes for the patients and communities we serve. We are dedicated to creating an environment where all employees feel valued, respected, and empowered to do their best work.