Patient Access & Prior Authorization Specialist

Moximed, Inc.; United States; On-site; USD 55,000 - 75,000; Full time

Job summary

Moximed, Inc. is seeking a detailed-oriented Case Manager to join our Patient Access team. The Case Manager handles insurance authorization and appeals, coordinating with physicians and patients to navigate the reimbursement landscape.

You will manage up to 150 cases, submit prior authorizations, draft appeal letters, and monitor payer trends to ensure timely decisions. Strong organization and communication are essential, as is experience with prior authorization processes and Salesforce.

Qualifications

• 3+ years’ experience in prior authorization and appeals management.
• Experience submitting prior authorization requests for medical procedures and interpreting procedure denials to draft appeals.
• Understanding and leveraging payer coverage criteria to ensure positive outcomes.
• 3+ years utilizing software systems to perform tasks, Salesforce preferred.
• High school diploma.

Responsibilities

• Submit and follow up on prior authorization requests to health plans.
• Persuasively engage health plans that are unwilling to review prior-authorization(s).
• Draft letters for appeal, external review, and administrative law judge hearings.
• Monitor and re-engage payer until final determination is made and all appeal rights are exhausted.
• Document all case-related communication to physicians, patients, and payers with chronology.
• Confirm accuracy of authorization approval details within approved timeframes prior to surgery.
• Monitor payer trends as it relates to approvals/denials and communicate trends to leadership.
• Communicate case status and required information to internal and external customers.
• Act as a resource for team members and new employees.
• Prioritize tasks according to urgency.
• Maintain a case volume up to 150 cases at a time.

Skills

Prior authorization

Appeals management

Payer criteria interpretation

Salesforce

Education

High school diploma

Tools

Salesforce

Job description

Moximed, Inc. is seeking a detailed-oriented Case Manager to join our Patient Access team. The Case Manager handles insurance authorization and appeals, coordinating with physicians and patients to navigate the reimbursement landscape.

You will manage up to 150 cases, submit prior authorizations, draft appeal letters, and monitor payer trends to ensure timely decisions. Strong organization and communication are essential, as is experience with prior authorization processes and Salesforce.