Patient Access Case Manager

Job Summary

Managing the patient case through the insurance authorization and appeal process, the full-time Patient Access Case Manager will work remotely to collaborate with the Interventional Spine team and external customers, ensuring effective communication and resolution of access obstacles.

Key responsibilities

• Follow up on prior authorization requests to health plans and ensure proper review for medical necessity
• Develop action plans for appeals by accurately identifying payer denial reasons and drafting necessary documentation
• Monitor payer trends related to approvals and denials, communicating findings to the team

Required qualifications

• 2+ years of experience in a pain management or spine prior authorization role, including reviewing clinical records and submitting prior authorization requests
• Experience in interpreting procedure denials and drafting appeals
• Understanding of payer coverage criteria to ensure positive outcomes
• 2+ years of experience utilizing software systems for task management