Remote Case Manager: Healthcare Appeals & Access

PRO-Spectus; Northern (KY); Hybrid; USD 55,000 - 74,000; Full time

Benefits offered by this job

401(k) with employer matching

Employee Ownership Program

Paid time off

Job summary

PRO-spectus is seeking a Case Manager for Healthcare Appeals & Patient Access Advocate to operate remotely in the United States. You will oversee the authorization and appeal journey for patients and providers, driving complex communications and expedited access to care while protecting payment outcomes.

The role requires strong critical thinking, collaboration with payor, clinical and client teams, and a focus on accurate, timely case resolution.

Qualifications

• College degree preferred with healthcare or insurance background.
• Experience writing Appeals is preferred.
• Strong communication and documentation skills.

Responsibilities

• Act as a single point of contact between internal team, client, providers, payor, facility, and patient.
• Support cases through approval/denial process with urgency and accuracy.
• Collaborate with Payor, Reimbursement, Clinical teams and client sales/MSL.
• Interpret complex clinical documentation for payor submissions.
• Provide resources for financial assistance and transportation to patients.

Skills

Effective communication

Multitasking

Case load management

Critical thinking

Problem solving

Customer service

Empathy

Education

Bachelor's or Associate Degree

Job description

PRO-spectus is seeking a Case Manager for Healthcare Appeals & Patient Access Advocate to operate remotely in the United States. You will oversee the authorization and appeal journey for patients and providers, driving complex communications and expedited access to care while protecting payment outcomes.

The role requires strong critical thinking, collaboration with payor, clinical and client teams, and a focus on accurate, timely case resolution.