Patient Access Appeals Case Manager
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Job Description
Patient Access Appeals Case Manager supporting healthcare access and reimbursement for DME device. Collaborating with patients, providers, and insurers to navigate the reimbursement process.
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 to identify and address any 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 any 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, as well as successful talk tracks and language used in successful 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, and 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 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 can-do attitude
- Excellent presentation and communication skills, with a strong emphasis on written communication
- Excellent analytical abilities
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