Patient Access Appeals Case Manager

Noctrix Health, Inc.; United States; Remote; USD 70,000 - 100,000; Full time

Job summary

Noctrix Health is seeking a Patient Access Appeals Case Manager in the United States to support patients through denial and appeal processes for our DME device. You will work with providers, insurers, and patients to secure access and reimbursement, while helping to develop reimbursement strategies and materials.

Ideal candidates have a BA/BS in a relevant field, 2+ years in healthcare, 1+ year in medical device reimbursement, and strong collaboration, communication and analytical skills.

Qualifications

• BA/BS degree in business, healthcare or marketing fields.
• 2+ years of healthcare sector experience.
• 1+ year in medical device reimbursement involving DME products.
• Experience leading projects and teams of reimbursement and billing professionals.
• Excellent collaboration, communication and analytical abilities.

Responsibilities

• Support patients, healthcare providers, and insurers regarding access and reimbursement for the DME device.
• Collaborate with providers to obtain documentation for claims and prior authorization.
• Coordinate with insurers to ensure timely and accurate processing of claims and authorizations.
• Stay updated on payer policies and coverage criteria to assist in obtaining coverage.
• Identify and address access or reimbursement challenges with cross-functional teams.
• Provide exceptional customer service to patients, providers and insurers.
• Develop training materials and tools for providers and patients to smooth the access process.
• Analyze denials, log trends, and support process optimization and best practices.

Skills

Collaboration

Written communication

Analytical abilities

Project leadership

Customer service

Education

BA/BS in business, healthcare or marketing fields

Job description

NoctrixHealth is redefining the treatment of chronic neurological disorders with clinicallyvalidatedtherapeutic wearables. Our team of medical device specialists, neuroscientists, and consumer electronics engineers is dedicated to delivering prescription-grade therapy withan outstandinguser experience. We have pioneered the world’s first drug-free wearable therapy, clinically proven to alleviate symptoms in adults with drug-resistant Restless Legs Syndrome(RLS). Be part of our mission to transform healthcare, improve lives, and drive meaningful change withNoctrixHealth.

The Patient Access Appeals Case Manager is responsible forsupporting patients through the denial and appeal process, coordinating with healthcare providers, insurance companies, and patients to ensure seamless access to our innovative DME device.This positionwill play a supportive role in ensuring the successful commercialization of our product by developing and executing reimbursement strategies,establishingrelationships with payers, and navigating the complex healthcare reimbursement landscape.

Responsibilities:

• Support patients, healthcare providers, and insurance companiesregardingaccess 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 ensuretimelyandaccurateprocessing of claims and prior authorization requests
• Stay up to date with insurance policies, coverage criteria, and reimbursement guidelines to provideaccurateinformation andassistin obtaining coverage for patients.
• Help toidentifyand 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 toidentifytrends 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
• Identifytrends 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+yearsin medical device reimbursement involving DME products
• Experience leading projects and teams of reimbursement and billing professionals
• Excellent collaboration skills andcan-do attitude
• Excellent presentation and communication skills, with a strong emphasis on written communication
• Excellent analytical abilities

Preferable :

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