Moximed, Inc. is seeking a detailed-oriented and organized Case Manager to join our Patient Access team. The Patient Access Case Manager is responsible for managing patient cases through the insurance authorization and appeal process. This role involves close collaboration with team members and external customers, including physicians and patients, to navigate obstacles in the patient access program and reimbursement environment.

B. Responsibilities

• Submit and follow up on prior authorization requests to health plans to ensure receipt and proper review for medical necessity.
• Persuasively engage health plans that are unwilling to review prior-authorization(s) based upon negative or absent coverage policy for MISHA.
• Draft letters for appeal, external review, and administrative law judge hearings.
• Monitor and re-engage payer until final determination is made, ensuring each available level of appeal is used and all appeal rights are exhausted.
• Document all case-related communication and activity to physicians, patients, and payers in a clear and concise manner to provide chronological details of case progress.
• Confirm accuracy of authorization approval details, ensuring 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 leadership.
• Clearly communicate with internal and external customers regarding patient access to MISHA, including but not limited to case status, needed information, TM involvement, reporting, etc.
• Act as a resource for fellow team members and new employees.
• Prioritize tasks according to urgency.
• Maintain a case volume up to 150 cases at a time.

JOB REQUIREMENTS:

A. Education and Training

• 3+ years’ experience in prior authorization and appeals management
• Experience submitting prior authorization requests for medical procedures and interpreting procedure denials to draft appeals
• Understanding and leveraging payer coverage criteria to ensure positive outcomes
• 3+ years utilizing software systems to perform tasks, Salesforce preferred
• High school diploma

B. Other Requirements

• <10% Travel

WHO WE ARE:

Moximed has built a team where innovation meets freedom for patients! Since the beginning, an entrepreneurial mindset and making patient care our number one priority has always guided our approach to work and the environment we create.

Our unique culture of empathy, enthusiasm, trust in each other, and resilience reflects our responsibility to our patient and our team. We organize around goal focused teamwork and transparent accountability to achieve our successes. we foster a culture of inclusion and belonging where all perspectives, abilities and experiences are valued and our people can reach their potential and truly thrive.

If you are a motivated, forward thinking, and creative person who is excited about transforming lives then Moximed might be a great fit for you.

At Moximed we believe that the unique contributions of all our team members create our success. To ensure that our culture continues to incorporate everyone’s perspectives and experience, we never discriminate based on race, religion, national origin, gender identity or expression, sexual orientation, age, marital, veteran, or disability status