Patient Access & Reimbursement Appeals Specialist

Noctrix-Health; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

NoctrixHealth is seeking a Patient Access Appeals Case Manager in the United States to support patients and providers through denial and appeal processes for our DME device. You will collaborate with payers and health plans to secure coverage and drive streamlined access, while developing reimbursement strategies.

A strong background in healthcare and appeals is required. You will help identify denial trends, develop best practices, and produce regular appeal metrics reports.

Qualifications

• BA/BS degree in business, healthcare or marketing, or equivalent experience.
• 2+ years in healthcare (pharmaceuticals or medical devices).
• Experience leading reimbursement and billing teams.
• Strong collaboration and can-do attitude.
• Excellent written and verbal communication; strong analytical abilities; experience in appeals, IRO and ALJ processes.

Responsibilities

• Support patients, healthcare providers, and insurers regarding access and reimbursement for our DME device.
• Collaborate with providers to obtain documentation for insurance claims and prior authorizations.
• Coordinate with insurers to ensure timely processing of claims and prior authorizations.
• Stay up-to-date with policies, coverage criteria, and guidelines 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, addressing inquiries.
• Develop training materials and tools for providers and patients to ensure a smooth access process.
• Analyze denials and log trends in denials, policies, and successful appeal language.
• Evaluate and enhance the appeals process for efficiency and effectiveness.
• Provide management with insights on trends and best practices to improve resolution workflow.
• Generate regular reports on appeal metrics including volumes and outcomes.

Skills

Communication

Collaboration

Analytical thinking

Project leadership

Healthcare knowledge

Education

Bachelor's degree in business, healthcare, or marketing

Job description

NoctrixHealth is seeking a Patient Access Appeals Case Manager in the United States to support patients and providers through denial and appeal processes for our DME device. You will collaborate with payers and health plans to secure coverage and drive streamlined access, while developing reimbursement strategies.

A strong background in healthcare and appeals is required. You will help identify denial trends, develop best practices, and produce regular appeal metrics reports.