Patient Access Appeals Case Manager
Noctrix Health, Inc.
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
JuniorMid-Level
About the role
- Support patients, healthcare providers, and insurance companies regarding access and reimbursement for our novel DME device
- Collaborate with healthcare providers to obtain necessary documentation and clinical information for insurance claims and prior authorization requests
- Coordinate with insurance companies to ensure timely and accurate processing of claims and prior authorization requests
- Stay up to date with insurance policies, coverage criteria, and reimbursement guidelines to provide accurate information and assist in obtaining coverage for patients.
- Help to identify and address any access or reimbursement challenges, working closely with cross-functional teams to develop solutions
- Provide exceptional customer service to patients, healthcare providers, and insurance companies, addressing inquiries and resolving any access-related issues.
- Collaborate with internal stakeholders to develop training materials, tools, and resources for healthcare providers and patients to ensure a smooth access process
- Assess incoming denials and log in the database to identify trends in denials, new medical policies, as well as successful talk tracks and language used in successful appeals
- Continuously evaluate and enhance the commercial appeals process for efficiency and effectiveness
- Identify trends in appeals and provide insights to management for process optimization, and implement best practices and industry benchmarks to drive improvements in the appeals resolution workflow
- Generate regular reports on appeal metrics, including volumes, resolution times, and outcomes
Requirements
- BA/BS degree in business, healthcare or marketing fields required 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical device reimbursementinsurance claims processingprior authorization requestsdata analysisreport generationtrend identificationappeals process optimizationdocumentation assessmentcustomer service
Soft skills
collaborationcommunicationpresentationanalytical abilitiesproblem-solvingteam leadershipcustomer service orientationadaptabilityattention to detail