Market Access Case Manager (Temporary)

Kandu, Inc.•Los Angeles, CA

8h•$35 - $40•Remote

About The Position

Kandu, Inc. is pioneering an integrated approach to stroke recovery by combining FDA-cleared brain-computer interface technology with personalized telehealth services. Our IpsiHand® device is durable medical equipment that enables chronic stroke survivors to regain upper extremity function with daily home use. Combining this advanced technology with the support of expert clinicians offers a comprehensive path to recovery–helping survivors improve mobility, independence, and quality of life. The Market Access Case Manager manages the prior authorization process for patients seeking insurance coverage for the IpsiHand Rehabilitation system. This full-time role is responsible for review of medical records and establishment of medical necessity, compilation and submission of applications for prior authorization and in-network gap exceptions, and negotiation of Single Case Agreements (SCAs) for patient-level device coverage. Case Managers work with patients across all US states and territories, and over 100 different Medicare Advantage, Commercial, and Managed Medicaid health plans.

Requirements

High School Diploma Or GED required. AA, BA, or BS desirable
Minimum three years experience working in a healthcare environment (medical devices,insurance, or healthcare services)
Experience in prior authorization submissions and appeals
Competency working in SalesForce, Google Suite, and Microsoft Office
Demonstrated customer service skills
Deep understanding of market access, reimbursement, and payer landscapes
Strong problem-solving and escalation management skills
Advanced communication skills (providers,patients,payers)
Ability to prioritize workload and manage complex cases independently
Understand types of insurance and their implications, including HMO, POS, and D-SNP plans, out-of-pocket obligations, provider networks, and Coordination of Benefits between primary and secondary insurance
Ability to sit at a computer for extended periods and use standard office equipment.
Ability to read and interpret clinical and insurance documents and communicate information clearly by phone and in writing.

Responsibilities

Review prescriptions, medical records, letters of medical necessity and case documentation provided by intake specialists for accuracy and completeness. Informed by these materials and health plan medical policy, develop patient-specific tactics and narratives to support medical necessity and positive coverage decisions.
Partner cross-departmentally and cross-functionally to address gaps in medical records, prescriptions, and prescriber credentials prior to submitting for prior authorization
Prepare, assemble, and submit prior authorization requests to health plans, including Medicare Advantage, Managed Medicaid, and Commercial insurers across all 50 states.
Serve as primary point of contact for insurance companies, following up by phone, fax and email to ensure timely and accurate processing of prior authorization requests
Identify and escalate systemic and plan-specific issues presenting challenges or opportunities to leadership
Complete accurate and timely documentation of all case-related information,records, and payer communications in company platforms
Identify the need for and request in-network gap exceptions when Neurolutions or its distributors are not in-network
Submit applications to health plans and negotiate payment rates for Single Case Agreements.
Shepherd agreed upon Single Case Agreements through contract execution, ensuring that fully-executed documents are received and recorded appropriately in company platforms in a timely manner
Partner cross-functionally with Commercial, Patient Intake, RCM and Clinical teams to share information, facilitate high-quality handoffs, and optimize patient experience
Identify and share best practices with peers and leadership team to support continued improvement in organizational competencies
May be assigned additional responsibilities to meet departmental and organizational priorities
Maintain up-to-date knowledge of payer requirements, clinical criteria, and regulatory changes that impact the prior authorization processes.
Comply with all HIPAA guidelines, ensuring that all documentation and communications are handled securely and confidentially
Recognize and report any product quality complaints in accordance with company SOPs