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.
The ideal candidate brings strong experience in DME reimbursement, denied claims, and post-service appeals, with the ability to independently interpret payer policies, assess medical necessity documentation, and navigate complex reimbursement challenges. This individual will serve as a key liaison among healthcare providers, payers, billing teams, patients, and internal stakeholders to ensure appeals are accurate, timely, clinically supported, and compliant with applicable payer requirements.
Independently manage post-service medical necessity appeals for DME claims from initial denial review through preparation, submission, follow-up, and final resolution
Review denied claims to identify denial rationale, documentation deficiencies, authorization issues, and the appropriate appeal or reconsideration strategy
Review medical records, physician notes, orders, clinical documentation, and supporting materials to determine whether documentation supports medical necessity and applicable payer coverage criteria
Research and interpret payer policies, medical necessity guidelines, coverage criteria, reimbursement requirements, and appeal procedures
Prepare and submit first-level, second-level, and other applicable appeals within payer-specific and regulatory deadlines
Draft clear, concise, and clinically supported appeal letters that directly address payer denial rationale and demonstrate medical necessity
Identify missing or insufficient clinical documentation and collaborate with healthcare providers and clinical teams to obtain information required to strengthen appeals
Communicate with insurance companies, payer representatives, and claims departments regarding appeal status, reconsiderations, documentation requirements, and final determinations
Maintain comprehensive tracking of appeals, including submissions, correspondence, follow-up activities, deadlines, payer decisions, and outcomes
Maintain accurate case notes and patient information within CRM, billing, and case management systems
Navigate payer-specific medical necessity criteria, documentation requirements, submission processes, and appeal timeframes
Apply knowledge of benefit investigations, prior authorizations, retro-authorizations, claims workflows, and their relationship to post-service appeals
Partner closely with Billing and Reimbursement teams to communicate appeal status, outstanding requirements, approvals, and next steps
Support prior authorization and other reimbursement appeals as business needs require
Identify recurring denial trends, documentation deficiencies, and payer-specific challenges and communicate findings to leadership and cross-functional stakeholders
Provide reporting and insights to leadership regarding claim denials, appeal outcomes, payer trends, and opportunities for process improvement
Educate healthcare providers and internal stakeholders on documentation requirements, medical necessity criteria, and common payer denial reasons
Collaborate with Patient Access, Reimbursement, Billing, Clinical, and other cross-functional teams to resolve complex reimbursement issues
Develop and maintain tools, resources, appeal templates, and training materials related to payer requirements, medical necessity, denial management, and post-service appeals
Consistently meet established quality, accuracy, productivity, and turnaround-time expectations
Maintain patient confidentiality and ensure all activities are performed in accordance with company policies, HIPAA, and applicable privacy requirements
