Patient Access Appeals Case Manager – VA
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Job Description
Patient Access Case Manager supporting patient reimbursement journeys for Noctrix Health's innovative therapy. Liaising between patients, providers, and insurance companies to ensure access.
Responsibilities:
- Serve as the primary point of contact for patients, healthcare providers, and insurance companies regarding access and reimbursement for Noctrix therapy
- Guide patients through the reimbursement process, including benefit verification, prior authorization, claims processing, and financial assistance programs
- Educate patients on insurance coverage, out-of-pocket responsibilities, and available support resources
- Collaborate with healthcare providers to obtain required clinical documentation and supporting information for prior authorization and reimbursement requests
- Coordinate with insurance companies to ensure timely and accurate review of claims and authorization requests
- Stay current on payer policies, coverage criteria, reimbursement guidelines, and industry changes impacting patient access
- Maintain accurate and detailed patient records, case notes, and documentation within CRM and reimbursement systems
- Identify and resolve access or reimbursement barriers by partnering with internal cross-functional teams
- Provide exceptional customer service while addressing patient, provider, and payer inquiries
- Support the development of patient and provider educational materials, tools, and resources designed to streamline the access process
- Assist with continuous improvement initiatives to optimize patient access workflows and reimbursement outcomes
Requirements:
- Bachelor's degree in Business, Healthcare Administration, Marketing, or a related field preferred
- Minimum of 5 years of experience within the healthcare industry, including pharmaceutical, medical device, or reimbursement-focused roles
- Minimum of 2 years of medical device reimbursement experience involving DME products
- Experience navigating commercial, Medicare, and government payer reimbursement processes
- VA and Medicare reimbursement experience preferred
- Strong understanding of benefit verification, prior authorizations, appeals, and reimbursement workflows
- Excellent verbal and written communication skills
- Strong analytical and problem-solving abilities
- Demonstrated ability to collaborate effectively across internal and external stakeholder groups
- Strong organizational skills with the ability to manage multiple patient cases simultaneously
- Experience with CRM systems and reimbursement platforms preferred
Benefits:
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
- Bonuses
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