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Clinical Appeals Specialist * Two Positions*
- Portsmouth, NH, USA
- Full Time
The Clinical Appeals Specialist is responsible for advocating overturning all medical necessity denials through payer-specific appeal processes to minimize the financial burden for patients. These positions will build and manage relationships with external and internal partners and will collaborate with and support the other Revenue Operations functional teams.
This is a full-time, exempt position reporting to the Manager of Case Management and is based in Portsmouth, NH.
Essential Duties & Responsibilities:
Understand and navigate government and commercial medical necessity appeal processes
Draft clinical summaries and appeal letters
Successfully overturn appeals by problem solving and creative thinking
Perform clinical chart reviews and provide feedback
Support internal and external audits as necessary
Review and prioritize insurance follow-up on accounts in a timely manner
Assist with documentation preparation for teleconference appeal hearings
Establish and maintain positive working relationships with internal and external partners
Work on any projects assigned to the team as necessary
All other duties or priorities assigned by management as needed
2-5 years in a medical device or DME company and/or clinical background
Bachelor's degree or equivalent experience
Strong knowledge of government and commercial appeals process preferred
Familiarity with the medical and oncology regulatory environments preferred
Familiarity with medical terminology, specific to oncology preferred
Experience with Microsoft Office and SAP preferred
Knowledge, Skills and Behaviors:
Excellent written and verbal communication skills
Demonstrated excellence in meeting and exceeding customer expectations
Effectiveness in de-escalating and resolving difficult situations
Ability to solve problems and set priorities
Ability to work independently with minimal supervision
Ability to work cooperatively in a fast-paced office setting
Ability to lift 20 pounds
Patient-forward: aspiring to make a difference in cancer.
Our patient-forward mission
Together with our patients, we strive to extend survival in some of the most aggressive forms of cancer by developing and commercializing our innovative therapy.
Our patient-forward values