Post-Service Appeals Case Manager

About Noctrix Health

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.

Position Summary

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