Nurse Appeals Analyst

4 weeks ago

Portsmouth, United States Novocure Full time
Description:

NURSE APPEALS SPECIALIST JOB SUMMARY:

The Nurse Appeals Analyst is responsible for managing and analyzing all medical content in relation to the reimbursement process, and supporting the Reimbursement team with appeals to minimize the financial burden for patients. The Nurse Appeals Analyst will also be responsible for preparing clinical summaries and representing Novocure in all teleconference hearings, ensuring that timeliness and guidelines are met, and appeals are handled in compliance with regulatory requirements of CMS and other agencies. This position will build and manage relationships with internal and external partners, including collaboration with and supporting other Revenue Operations functional teams.

This is a full-time, exempt (salaried) position reporting to Manager, RN Clinical Appeals, based in Portsmouth, NH. This role is hybrid (Tuesdays, Wednesday, Friday remote/ Monday, Thursday on-site).

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Analyze medical records to provide accurate information according to policies and procedures
  • Analyze data for all levels of appeal process and develop improved methodologies for future cases in order to successfully overturn denials
  • Provide accurate and thorough testimony for teleconference hearings, including ALJ and State Fair Hearings
  • Utilize problem solving and creative thinking in order to prepare clinical summaries and appeal letters, with the ability to review and edit templates as needed
  • Manage and maintain confidential information, ensuring it is handled securely and in compliance with the Novocure's policies and procedures
  • Efficiently manage multiple tasks and deadlines, ensuring that all assignments are completed accurately and in a timely manner
  • Establish and maintain positive working relationships with internal and external partners
  • Support internal and external audits as necessary
  • Support and manage projects assigned to the team as necessary
  • All other duties or priorities assigned by management as needed

QUALIFICATIONS/KNOWLEDGE:

  • 1-3 years in a medical device or DME company and/or clinical background
  • LPN or RN required, Bachelor's degree or equivalent experience preferred
  • Familiarity with medical terminology, specific to oncology preferred
  • Strong knowledge of government and commercial appeals process preferred
  • Excellent written and verbal communication skills required
  • Experience with Microsoft Office and SAP preferred
  • Ability to follow directions and adhere to company policies and procedures required
  • Effectiveness in de-escalating and resolving difficult situations required
  • Ability to solve problems and set priorities required
  • Ability to work independently with minimal supervision required
  • Ability to work cooperatively in a fast-paced office setting required

ABOUT NOVOCURE:

Our vision

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

- innovation

- focus

- drive

- courage

- trust

- empathy

An Equal Opportunity Employer, including disability/veterans

#LI-YS1

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