Case Manager – Healthcare Appeals, Patient Access Advocate

This is a fully remote position, open to applicants in United States.

📋 Description

• Serve as the main liaison among internal teams, clients, providers, payors, facilities, and patients.

• Assist cases through the approval and denial processes with promptness and precision.

• Coordinate with both internal and external stakeholders to guarantee case accuracy and thoroughness.

• Recognize and communicate business-process trends to management.

• Prioritize client tasks and follow up with customers to address issues.

• Create innovative solutions for clients and payors in uncertain situations.

• Make autonomous decisions in urgent and non-standard client and patient scenarios.

• Analyze intricate clinical documentation and prepare authorization materials for payor submission.

• Collaborate with interdisciplinary teams throughout the case lifecycle to ensure successful outcomes.

• Offer financial assistance and transportation resources to patients, caregivers, providers, and clients.

• Deliver compassionate and empathetic support to patients and their caregivers.

⛳️ Requirements

• 4–6 years of experience in a healthcare environment and/or a medical insurance background with a focus on customer service.

• Proven experience in maintaining detailed records of client interactions, services rendered, and progress achieved.

• Background in office, hospital/clinic, or home healthcare settings is a plus.

• Experience in developing and/or implementing new technologies is advantageous.

• Familiarity with complex medical products and their associated insurance processes is beneficial.

• Experience in writing appeals is preferred.

• Strong comprehension of the US Healthcare System, including public and private payer nuances and patient access difficulties.

• Ability to interpret and understand medical documentation and apply it to specific medical policy standards.

• Skill in coordinating multiple priorities and activities effectively.

• Capability to independently manage a caseload, prioritize tasks, and apply time management skills.

• Strong critical thinking and problem-solving abilities.

• Effective oral and written communication skills.

• Ability to develop, maintain, and navigate professional relationships.

• Adaptability to rapidly changing processes and consumer demands.

• Willingness to work hours supporting activities across various time zones.

• A college degree (Bachelor's or Associate Degree) is preferred but not required.

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance plans.

• Life insurance and disability coverage.

• Tax-advantaged savings accounts.

• Employee Assistance Program.

• Home office benefits.

• Employee Ownership Program.

• Paid time off.

• Paid holidays.

• Bereavement leave.

• 401(k) retirement plan with employer matching.

• Performance-based bonus opportunities.

• Supportive, dedicated, and teamwork-oriented culture.

• Opportunities for career advancement.