Post-Service Appeals Case Manager

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 detail-oriented Post-Service Appeals Case Manager to manage medical necessity appeals and support the successful resolution of denied durable medical equipment (DME) claims after service has been provided. This role is responsible for evaluating claim denials, reviewing clinical documentation, researching payer requirements, developing appeal strategies, and independently managing post-service appeals through resolution. 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. This position reports to the Director, Patient Access . Responsibilities: 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…