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Noctrix Health, Inc. · 9 hours ago

Patient Access Appeals Case Manager

United States

Full-time

Remote

Mid, Senior Level

3+ years exp

Noctrix Health is redefining the treatment of chronic neurological disorders with clinically validated therapeutic wearables. The Patient Access Appeals Case Manager is responsible for supporting patients through the denial and appeal process, coordinating with healthcare providers, insurance companies, and patients to ensure seamless access to the innovative DME device.

Health CareMedical DeviceTherapeutics

Responsibilities

Support patients, healthcare providers, and insurance companies regarding access 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 ensure timely and accurate processing of claims and prior authorization requests

Stay up to date with insurance policies, coverage criteria, and reimbursement guidelines to provide accurate information and assist in obtaining coverage for patients

Help to identify and 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 to identify trends 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

Identify trends 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

Qualification

Healthcare reimbursementMedical device experienceProject leadershipAnalytical abilitiesCollaboration skillsPresentation skillsCustomer serviceTraining developmentCommunication skillsProblem-solving