Patient Access Appeals Case Manager

Responsibilities

• Support patients, healthcare providers, and insurance companies regarding access and reimbursement for novel DME devices
• Collaborate with healthcare providers to obtain documentation for insurance claims and prior authorization requests
• Coordinate with insurance companies to ensure timely and accurate processing of claims
• Stay updated on insurance policies, coverage criteria, and reimbursement guidelines
• Identify and address access or reimbursement challenges with cross-functional teams
• Provide exceptional customer service to patients and providers
• Develop training materials and resources for healthcare providers and patients
• Assess and log incoming denials to identify trends and successful appeal strategies
• Evaluate and enhance the commercial appeals process for efficiency
• Generate regular reports on appeal metrics, volumes, and outcomes

Requirements

• BA/BS degree in business, healthcare, or marketing (or equivalent experience)
• 2+ years of experience in the healthcare sector (pharmaceutical and medical device)
• 1+ years in medical device reimbursement involving DME products
• Experience leading projects and teams of reimbursement and billing professionals
• Excellent collaboration, presentation, and communication skills
• Strong analytical abilities

Preferred Qualifications

• Experience in appeals, IRO, and ALJ processes
• Experience with insurance complaints and state fair hearings

About the Company

Noctrix Health is redefining the treatment of chronic neurological disorders with clinically validated therapeutic wearables. The team is dedicated to delivering prescription-grade therapy with an outstanding user experience, pioneering drug-free wearable therapy for Restless Legs Syndrome (RLS).