Patient Access Appeals Case Manager

🕒 August 5

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

👻 Ghost score 35%

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Noctrix Health, Inc.

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2018

🏥 Healthcare

💼 Consulting

🍽️ Food & Beverage

Healthcare • Consulting • Food & Beverage

Noctrix Health, Inc. is a pioneering company focused on developing next-generation, clinically validated wearable therapeutics aimed at managing chronic neurological disorders. With a mission to address the unmet needs of individuals living with such conditions, Noctrix combines expertise from seasoned medical device experts, neuroscientists, and engineers to deliver innovative therapies that enhance user experience. The company's flagship product, Nidra, has received FDA Breakthrough Device Designation and is designed for conditions like Restless Legs Syndrome, representing a promising advancement in wearable health technology.

📋 Description

• Support patients, healthcare providers, and insurance companies regarding access and reimbursement for the novel DME device • Collaborate with healthcare providers to obtain 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 current on insurance policies, coverage criteria, and reimbursement guidelines • Identify and address access or reimbursement challenges with cross-functional teams • Provide customer service and resolve access-related issues for patients, healthcare providers, and insurance companies • Develop training materials, tools, and resources for healthcare providers and patients • Assess incoming denials and log them in the database to identify denial trends, medical policies, and successful appeal language • Evaluate and enhance the commercial appeals process • Identify appeals trends, provide management insights, and implement best practices and industry benchmarks • 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 experience in pharmaceutical and medical device industries • 1+ years of medical device reimbursement experience 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, especially written communication • Excellent analytical abilities • Preferable: experience in appeals, IRO, and ALJ processes • Preferable: experience with insurance complaints and State Fair Hearings

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