The Patient Access Case Manager is responsible for managing the patient authorization and appeal process. Working closely with Relievant team members and external customers (Physicians and Patients) to identify and overcome obstacles in the patient access program and reimbursement enviornment.
- Prior Authorization submission as needed to assist the team achieving identified goals and objectives.
- Monitor and re-engage payer until final determination is made – ensuring each level of appeal is used and all appeal rights are exhausted.
- Complete all communication to physician, patients and payers in a clear and accurate manner.
- Document all account activity and correspondence for cases in a timely/accurate manner so any team member can see exactly what is happening with each case and act on it as needed.
- Confirm accuracy of authorization details, ensure all codes are captured and authorization is within approved timeframes prior to surgery.
- Manage and monitor payer trends as it relates to approvals/denials and communicate trends to the team.
- Prioritize tasks according to urgency:
- Expected Total case volume 110 – 130
- Expected patients per day 25 – 30
- Minimum 2 years medical Insurance authorization experience (preferred).
- Minimum 1-year claim appeal experience (preferred).
Skills / Aptitudes:
- Demonstrated ability to navigate the prior authorization and appeals process with commercial and government payers.
- Ability to follow process and protocol and communicate when/if changes are needed.
- Ability to work within multiple software systems.
- Ability to adapt as the needs of the business change or evolve.
- Excellent verbal and written communication skills.
- Excellent interpersonal skills.
- Secure home office space with ability to protect HIPAA sensitive materials.
- Must be willing to travel as needed (<5%).
- High School Diploma or equivalent
- Certified in Outpatient Coding (COC) preferred.
- Anywhere in the United States. This position is 100% remote
Where permitted by applicable law, employees of Relievant Medsystems are required to be fully vaccinated against COVID-19 as a condition of employment. If an applicant is unable to be vaccinated due to a medical condition or a sincerely held religious belief, practice, or observance, Relievant may provide reasonable accommodations.
We are proud to offer our employees an excellent compensation and benefits package and we are an equal opportunity employer.
For more information or to apply, please add the name of the position in the subject line along with your resume to: email@example.com.