Senior Patient Case Advocate

Senior Patient Care Advocate

Headquarters is in Santa Clara, CA.  

SI-BONE® is focused on helping patients in one of the most under-served, under-diagnosed, and under-treated areas in orthopedics, the sacroiliac (SI) joint. SI-BONE developed an innovative, patented implant to fuse the SI joint. The iFuse Implant System® provides a less invasive alternative to traditional sacroiliac (SI) joint fusion surgery and has been used in over 90,000 procedures to date. 

We are a medical device company that is focused on improving the lives of patients with sacroiliac pelvic conditions. We are looking for people who are passionate about our mission and who are willing to work hard to achieve it. We are also looking for people who are: 

• Agile: We work in a fast-paced environment and need to be able to learn and adapt to change quickly. 

• Creative: We embrace creativity, and we need people who are not afraid to challenge the status quo. 

• Team Players: We roll-up our sleeves and work together as one team to achieve our goals. 

General Responsibilities:

The Senior Patient Case Advocate must act and conduct company business in an honest, ethical and lawful manner, consistent with the company’s Code of Conduct, other company policies and the AdvaMed Code of Conduct and/or any other applicable industry code(s) of conduct. The company does not tolerate retaliation in connection with making good faith reports of suspected violations.

Specific Responsibilities and Skills:

• Acts as single point of contact and voice for regional providers, patients, and the sales team.
• Investigate payor coverage policies related to SI Joint fusion.
• Ensure patient medical documentation supports the highest opportunity for a successful pre-authorization or appeal.
• Coordinates access to SI-BONE products, conducts appropriate follow-up and facilitates access to surgery.
• Responsible for performing all duties in compliance with all applicable worldwide regulatory requirements as included in the scope of the SI-BONE Quality Manual
• Serves as a patient advocate to help patients navigate the reimbursement process to obtain access to minimally invasive SI Joint fusion surgery with SI-BONE products.
• Partner with Area Reimbursement Manager on case authorization and appeal strategies
• Provide effective collaboration as the liaison between the patient, providers/providers’ offices, and payor to coordinate attempt to secure coverage for SI-BONE products.
• Ensure high quality customer service and frequent interaction with provider’s offices and patients regarding case status and outcome of pre-authorizations and appeals in company’s case management program.
• Aid physician’s office staff and patients to complete and submit all necessary insurance forms and program applications in a timely manner.
• Provide exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Process any correspondence; ensure accurate and thorough case documentation in database.
• Coordinate securing patients supporting medical documentation, letters of medical necessity and appeal letter signatures from referring providers.
• Provide Territory Manager or other sales management personnel with case updates, as appropriate and in accordance with company and departmental procedures.
• Track, monitor and report the outcomes of reimbursement initiatives (example: appeal outcomes from peer – peer reviews, external [independent] medical reviews, trends, observed from the various initiatives, etc.
• Demonstrates leadership and mentoring skills
• Other duties as assigned.
• Support the SI-BONE Quality System

Knowledge, Education and Experience:

• Bachelor’s Degree preferred
• Nursing Degree, a plus
• Medical device experience a plus
• Certified professional coder preferred
• 10+ years’ experience with health insurance benefits investigations, and reimbursement along with billing and coding
• Experience supporting appeals for experimental and investigational procedures

Expertise and Attributes:

• Excellent written and verbal communication skills
• Assist patients with understanding what they need, listen, and communicate with insurance providers, doctors, nurses and specialists, and relay this information back to their clients as appropriate.
• Excellent customer service skills with a focus on assisting patients in a healthcare environment.
• Strong attention to detail, time management and organizational skills.
• Demonstrates a positive 'can do' attitude.
• Possess a demonstrated ability to communicate effectively and work well with others throughout the Company.
• Possess effective problem-solving skills.
• Be known as a person who has high integrity, sound character, a tremendous work ethic and the passion to succeed.
• Knowledge and familiarity of applicable regulations/standards (e.g. ISO 13485, FDA 21 CFR 820, EU MDR 2017/745, ISO 14971) as required to perform the job function.

Salary range:  $66,000- $74,000. The compensation range for this position is specific to the location and is in good faith what SI-BONE expects to pay for the position taking into account the wide variety of factors that are considered in making compensation decisions, including job-related knowledge; skillset; experience, education and training; certifications; and other relevant business and organizational factors.

Supplemental pay: bonus and stock