Patient Access Appeals Case Manager

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

📋 Description

• Assist patients, healthcare providers, and insurance companies with access and reimbursement for the innovative DME device.

• Collaborate with healthcare providers to gather documentation and clinical information necessary for insurance claims and prior authorization requests.

• Liaise with insurance companies to guarantee prompt and precise processing of claims and prior authorization requests.

• Keep updated on insurance policies, coverage criteria, and reimbursement guidelines.

• Identify and tackle access or reimbursement challenges in collaboration with cross-functional teams.

• Deliver customer service and resolve access-related issues for patients, healthcare providers, and insurance companies.

• Create training materials, tools, and resources for healthcare providers and patients.

• Analyze incoming denials and log them in the database to identify trends in denials, medical policies, and effective appeal language.

• Assess and improve the commercial appeals process.

• Spot appeals trends, provide insights to management, and implement best practices and industry benchmarks.

• Produce regular reports on appeal metrics, including volumes, resolution times, and outcomes.

⛳️ Requirements

• A BA/BS degree in business, healthcare, or marketing is required, or equivalent experience.

• A minimum of 2 years of experience in the healthcare sector, specifically within pharmaceutical and medical device industries.

• At least 1 year of experience in medical device reimbursement related to DME products.

• Proven experience in leading projects and teams of reimbursement and billing professionals.

• Strong collaboration skills and a proactive attitude.

• Excellent presentation and communication skills, particularly in written form.

• Strong analytical capabilities.

• Preferred: experience in appeals, Independent Review Organizations (IRO), and Administrative Law Judge (ALJ) processes.

• Preferred: experience with insurance complaints and State Fair Hearings.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Opportunities for professional development and training.

• Flexible working hours and remote work options.

• A supportive and collaborative work environment.