Case Management Specialist
Tactile Medical is the leader in at-home treatment options for chronic conditions including lymphedema and venous insufficiency. Headquartered in NE Minneapolis, we advocate for patient access and serve tens of thousands of patients through a national network of sales representatives, trainers, reimbursement experts, patient advocates, and clinical staff. For the past five years, we have been voted by our employees as a “Star Tribune Top Workplace" in Minnesota. We are very proud that we have been named a 2016 Top Workplace again!
The Case Management Specialist will be responsible for the development and implementation of payer strategies and patient appeals to ensure optimized coverage and reimbursement for company products. Writing persuasive letters of medical necessity and appeals to Providers and Insurance companies to overturn denials. Provide guidance to Reimbursement Department to improve payer communications, including global communications. Assist the Reimbursement Department by obtaining pertinent clinical documentation requested by payers to ensure individual prior authorizations and claim appeals are approved. Research and develop payer climate synopsis when requested by Product Specialists. Effectively communicate details of medical necessity and non-contractual denials to patients, and clinicians. Perform all job duties while maintaining compliance with all appropriate regulatory requirements including HIPAA.
Main Job Duties:
• Develop well-written commercial payer prior auth and appeal packages that address all of the payer’s objections and prove medical necessity within the guidelines using clinical information and studies/research available. If denied, assess case to determine when and if appropriate to continue appeal efforts.
• Develop a strategic plan to overcome adverse payer criteria by targeting specific payers that routinely deny the Flexitouch. Educate payer clinical review staff and/or medical directors about lymphedema and the treatment provided by the Flexitouch.
• Develop and foster a strong and effective relationship with insurance carriers. Develop relationships with key payer personnel to allow Tactile Systems the ability to demonstrate the cost and medical benefits to the Flexitouch system for use with Lymphedema and wound care as well as any future uses that prove to be beneficial to the patient.
• Identify beneficial contracting opportunities. Identify payers for whom in-network status contributes to positive revenue growth. Alert the Contracting Department of these opportunities.
• Educate patients and clinicians regarding general payer criteria. Direct questions and inquiries in a manner that allows for all necessary information to be gathered with minimal inconvenience to all.
• Provide ongoing review of internal reimbursement documentation. Monitor and follow individual patient appeals to ensure the patient receives timely approval.
• Other duties as assigned by manager. Respond to requests for data by manager as needed. Maintain compliance with all appropriate regulatory requirements including HIPAA.
• Bachelor Degree or equivalent experience required, clinical background preferred
• Experience in persuasive writing, case review to assess coverage criteria, medical terminology, critical thinking, and problem solving preferred
• Experience in medical device industry, health insurance, or related field strongly preferred
• Travel 5-10 percent
• Understanding of health insurance methodologies (coding, coverage, prior authorizations,
clinical criteria, payments)
Visit TactileMedical.com to learn more about our company and this great opportunity!
Tactile Medical is an exciting, innovative company with incredible career growth opportunities. We offer competitive wages and benefits including; Medical, dental, & Vision insurance, flexible spending accounts, PTO, and 401k and Roth Plans. We also offer an annual bonus program set on specific criteria.
Tactile Medical is an equal employment opportunity / affirmative action employer. We do not discriminate in our employment practices or opportunities on any grounds as prohibited by federal, state, or local law. Any applicant requiring reasonable accommodations during the application and/or interview process should contact Human Resources.