Post-Service Appeals Case Manager

Responsibilities

• Independently manage post-service medical necessity appeals for DME claims from initial denial through final resolution
• Review denied claims to identify rationale, documentation deficiencies, and appropriate appeal strategies
• Review medical records, physician notes, and clinical documentation to determine medical necessity
• Research and interpret payer policies, medical necessity guidelines, and reimbursement requirements
• Prepare and submit first-level and second-level appeals within regulatory deadlines
• Draft clear, clinically supported appeal letters addressing payer denial rationale
• Collaborate with healthcare providers to obtain necessary clinical documentation
• Communicate with insurance companies and payer representatives regarding appeal status
• Maintain comprehensive tracking of appeals, correspondence, and outcomes in CRM and billing systems
• Identify recurring denial trends and provide insights to leadership for process improvement
• Educate internal stakeholders and providers on documentation requirements and payer criteria

Requirements

• Bachelor's degree in Business, Healthcare Administration, Health Sciences, or related field preferred
• Minimum 5 years of healthcare industry experience (medical device, DME, reimbursement, or billing)
• Minimum 2 years of medical device reimbursement experience involving DME products
• Proven experience managing post-service appeals, claim denials, or medical necessity appeals
• Strong understanding of DME reimbursement, benefit investigations, and prior/retro-authorizations
• Ability to independently research and interpret complex payer policies and coverage criteria
• Excellent written communication skills for drafting persuasive clinical appeal documentation
• Strong analytical, problem-solving, and organizational skills to manage high-volume workloads
• High attention to detail and commitment to HIPAA compliance

Preferred Qualifications

• Direct experience managing post-service DME medical necessity appeals
• Experience working with both commercial insurance plans and government payers
• Experience with retro-authorization and authorization-related claim denials
• Proficiency with CRM or billing systems, specifically Salesforce
• Experience working within a high-growth medical device or healthcare organization

About the Company

Noctrix Health is redefining the treatment of chronic neurological disorders with clinically validated therapeutic wearables. Our team of medical device specialists, neuroscientists, and consumer electronics engineers is dedicated to delivering prescription-grade therapy with an outstanding user experience.