Patient Access Appeals Case Manager (VA)

Noctrix Health is redefining the treatment of chronic neurological disorders with clinically validated therapeutic wearables. Our team of medical device specialists, neuroscientists, and consumer electronics engineers is dedicated to delivering prescription-grade therapy with an outstanding user experience. We have pioneered the world’s first drug-free wearable therapy, clinically proven to alleviate symptoms in adults with drug-resistant Restless Legs Syndrome (RLS). Be part of our mission to transform healthcare, improve lives, and drive meaningful change with Noctrix Health. 

We are seeking an experienced and patient-focused Patient Access Case Manager (VA) to support patients throughout the access and reimbursement journey for Noctrix Health's innovative durable medical equipment (DME) therapy. In this role, you will serve as the primary liaison between patients, healthcare providers, and insurance companies to ensure timely access to therapy while delivering an exceptional patient experience.

The Patient Access Case Manager will guide patients through benefit investigations, prior authorizations, reimbursement processes, and financial clearance activities. The ideal candidate will have a strong background in medical device reimbursement, payer navigation, and patient support, along with exceptional communication and problem-solving skills.

This role reports to the Director, Patient Access and plays a critical role in helping patients access life-changing therapy while supporting Noctrix Health's mission to improve the lives of individuals living with Restless Legs Syndrome.

This is a full-time position.

Responsibilities:

• Serve as the primary point of contact for patients, healthcare providers, and insurance companies regarding access and reimbursement for Noctrix therapy
• Guide patients through the reimbursement process, including benefit verification, prior authorization, claims processing, and financial assistance programs
• Educate patients on insurance coverage, out-of-pocket responsibilities, and available support resources
• Collaborate with healthcare providers to obtain required clinical documentation and supporting information for prior authorization and reimbursement requests
• Coordinate with insurance companies to ensure timely and accurate review of claims and authorization requests
• Stay current on payer policies, coverage criteria, reimbursement guidelines, and industry changes impacting patient access
• Maintain accurate and detailed patient records, case notes, and documentation within CRM and reimbursement systems
• Identify and resolve access or reimbursement barriers by partnering with internal cross-functional teams
• Provide exceptional customer service while addressing patient, provider, and payer inquiries
• Support the development of patient and provider educational materials, tools, and resources designed to streamline the access process
• Assist with continuous improvement initiatives to optimize patient access workflows and reimbursement outcomes

First 90 Days Success Plan:

Day 30 Objectives

By Day 30, a successful Patient Access Case Manager will be able to:

• Complete product training and assigned quality trainings
• Navigate CRM and billing systems to enter notes and locate customer information
• Independently perform benefit investigations and prior authorization submissions

Day 60 Objectives

By Day 60, a successful Patient Access Case Manager will be able to:

• Negotiate single-case agreements for approved patients
• Address common payer objections using approved responses and escalation pathways
• Confidently answer patient questions regarding TOMAC therapy

Day 90 Objectives

By Day 90, a successful Patient Access Case Manager will be able to:

• Deliver financial clearance information and obtain patient acceptance to proceed
• Send service agreements and enter sales orders accurately
• Independently manage an assigned territory or patient population
• Proactively support team members when workload permits

Requirements:

• Bachelor's degree in Business, Healthcare Administration, Marketing, or a related field preferred
• Minimum of 5 years of experience within the healthcare industry, including pharmaceutical, medical device, or reimbursement-focused roles
• Minimum of 2 years of medical device reimbursement experience involving DME products
• Experience navigating commercial, Medicare, and government payer reimbursement processes
• VA and Medicare reimbursement experience preferred
• Strong understanding of benefit verification, prior authorizations, appeals, and reimbursement workflows
• Excellent verbal and written communication skills
• Strong analytical and problem-solving abilities
• Demonstrated ability to collaborate effectively across internal and external stakeholder groups
• Strong organizational skills with the ability to manage multiple patient cases simultaneously
• Experience with CRM systems and reimbursement platforms preferred

Preferred Qualifications:

• Experience supporting novel or emerging medical device therapies
• Experience negotiating single-case agreements and managing complex reimbursement scenarios
• Familiarity with patient access programs and financial assistance resources
• Prior experience in a high-growth medical device or healthcare organization

Compensation:

• Base pay: $70,000 - $85,000 + bonus