Description
The core function of the Clinical Appeals Specialist (CAS) role is to compose a cohesive clinical prior authorization request with supporting medical documentation for Myomo products, ultimately supporting the establishment of medical necessity.
The ideal candidate is highly detailed and self-organized with strong communication skills across multiple modes. He/she understands the gravity and importance of both accurate and complete clinical documentation, brings former background with the insurance ecosystem, and maintains a disciplined follow-up cadence.
Responsibilities
- Maintain and monitor patient caseload, adhering to insurance deadlines.
- Review patient medical records in order to establish medical necessity for Myomo products.
- Review policy, crafting a written appeal in response to insurer-specific denials.
- Audit payer policies, updating resources ad hoc.
- Ensure alignment and strategic processes through intra/interdepartmental communications.
- Develop and update ongoing resources collaboratively with management, regarding insurance policies, operational strategies, and analysis of authorization/denial trends.
- Meet with manager regularly as needed, sharing key updates and metrics.
- Attend department and company meetings as scheduled; assist in training new staff if needed.
- Meet productivity expectations as outlined in performance goals.
Requirements
- Graduate degree from an accredited physician assistant, nursing, occupational therapy or physical therapy program required.
- At least 1-3 years of direct patient care experience in a hospital or outpatient setting with
patients who commonly suffer upper extremity weakness as a result of illness/injury OR previous background in health insurance, medical device, biotechnology, or a pharmaceutical policy environment. - Well-versed in medical terminology; comfortable reading and interpreting medical records from various medical specialties and/or allied health professionals.
- Comfortable with common computer programs including MS Office, Gmail, Adobe, & EMR systems.
- Excellent written/verbal, interpersonal, and organizational skills with strong attention to detail.
- Comfortable in a fast-paced setting with the ability to prioritize and adapt amid an evolving environment.
- Ability to meet deadlines with specified time constraints, planning tasks and work accordingly.
- Ability to work well both independently as well as collaboratively in a team environment.
About Myomo, Inc
Myomo, Inc. is a medical myoelectric company that offers expanded mobility for those suffering from neurological disorders and upper-limb paralysis. Myomo develops and markets the MyoPro® product line of lightweight, non-invasive, powered arm braces (orthoses) to restore function in the paralyzed or weakened arms and hands of individuals that have suffered a stroke, spinal cord or nerve injury such as brachial plexus injury, or other neuro-muscular disability such as multiple sclerosis (MS). It is the only device that, sensing a patient’s own neurological signals through non-invasive sensors on the arm, can restore their ability to use their arms and hands so that they can return to work, live independently and reduce their cost of care.
At Myomo, we are driven by a mission to enable independence and confidence for stroke survivors as well as those living with MS, BPI, and other neurological disorders. Our teams continue to break through barriers, defining the limits of what is possible in both medical device robotics and our global system of care.