Patient Access Appeals Case Manager

About the role

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. We have pioneered the world’s first drug-free wearable therapy, clinically proven to alleviate symptoms in adults with drug-resistant Restless Legs Syndrome (RLS). Be part of our mission to transform healthcare, improve lives, and drive meaningful change with Noctrix Health.

The Patient Access Appeals Case Manager supports patients through the denial and appeal process, coordinates with healthcare providers and insurance companies, and ensures seamless access to our innovative DME device. This role plays a key part in the successful commercialization of our product by developing and executing reimbursement strategies, establishing payer relationships, and navigating the complex healthcare reimbursement landscape.

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 identify and address 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 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, and successful talk tracks and language used in 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
• 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

Requirements

• BA/BS degree in business, healthcare, or marketing fields required 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 skills and a can-do attitude
• Strong presentation and communication skills, with a focus on written communication
• Excellent analytical abilities

Preferred Qualifications

• Experience in appeals, IRO, and ALJ processes
• Experience with Insurance Complaints and State Fair Hearings