Patient Access Case Manager

Job Summary

A company is looking for a Patient Access Case Manager.

Key Responsibilities

• Manage patient cases through the insurance authorization and appeal process
• Draft and submit appeal letters, monitor payer responses, and ensure all appeal rights are exhausted
• Document case activities and communicate effectively with internal and external stakeholders regarding patient access

Required Qualifications

• 2+ years of experience in a pain management or spine prior authorization role
• Experience in reviewing clinical records and submitting prior authorization requests
• Ability to interpret procedure denials and draft appeals
• Understanding of payer coverage criteria
• 2+ years of experience utilizing software systems for task management