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:

Remote work environment with secure workspace
Up to 5+ years of experience in patient access, reimbursement, or prior authorization management
Demonstrated experience managing complex appeals and IRO reviews
Deep familiarity with payer authorization platforms including Availity
Experience using Salesforce CRM or similar workflow systems
Strong persuasive writing and payer negotiation skills
Ability to balance speed of case movement with strategic payer engagement
Experience navigating coverage for medical devices or emerging healthcare technologies preferred
Women’s health experience preferred but not required
Ability to work independently while contributing to a team-based environment
Experience with development of authorization and appeal templates that strengthen submissions
Ability to collaborate with Market Access leadership to identify coverage expansion opportunities

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.

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Patient Access Senior Specialist