Patient Access Case Manager

Job Summary

Managing patient cases through the insurance authorization and appeal process, the remote Patient Access Case Manager will work closely with the Interventional Spine team and external customers to identify and overcome obstacles in the patient access program and reimbursement environment.

Key responsibilities

• Follow up on prior authorization requests to ensure proper review for medical necessity
• Draft appeal letters and participate in administrative law judge hearings on behalf of patients
• Document all case activity and monitor payer trends related to approvals and denials

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 interpreting procedure denials and drafting appeals
• Understanding of payer coverage criteria to ensure positive outcomes
• 2+ years of experience utilizing software systems for task performance