Patient Access Appeals Case Manager

The role

The Patient Access Appeals Case Manager supports patients through the denial and appeal process. This role coordinates with healthcare providers and insurance companies to ensure access to a DME device.

What you will do

• Support patients, healthcare providers, and insurance companies regarding access and reimbursement
• Collaborate with healthcare providers to obtain documentation for insurance claims and prior authorization
• Coordinate with insurance companies to ensure timely processing of claims and prior authorization
• Stay up to date with insurance policies, coverage criteria, and reimbursement guidelines
• Identify and address access or reimbursement challenges with cross-functional teams
• Provide customer service to patients, healthcare providers, and insurance companies
• Collaborate with internal stakeholders to develop training materials, tools, and resources
• Assess incoming denials and log in the database to identify trends
• Evaluate and enhance the commercial appeals process
• Generate regular reports on appeal metrics

Required qualifications

• BA/BS degree in business, healthcare or marketing fields or equivalent experience
• 2+ years of healthcare sector (pharmaceutical and medical device)
• 1+ years in medical device reimbursement involving DME products
• Experience leading projects and teams of reimbursement and billing professionals
• Excellent collaboration skills and can-do attitude
• Excellent presentation and communication skills, with a strong emphasis on written communication
• Excellent analytical abilities

Nice to have

• Experience in appeals, IRO, and ALJ process
• Experience with Insurance Complaints and State Fair Hearings

About the company

Noctrix Health is redefining the treatment of chronic neurological disorders with clinically validated therapeutic wearables. The team consists of medical device specialists, neuroscientists, and consumer electronics engineers.