Kandu, Inc.

Compensation

Full Description

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. What You’ll Do Prior Authorization and In-Network Gap Exceptions 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 Single Case Agreements 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 Collaboration 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 Compliance 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 What You’ll Bring 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 Skills and competencies 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 Other requirements 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. Work Environment and Schedule This position is primarily remote depending on company policy. Occasional travel may be required for team meetings. Standard business hours apply, with flexibility to address urgent What We Offer: Competitive Compensation ($35 to $40 hourly DOE) Please note that the salary information is a general guidance only. Kandu, Inc. considers factors such as scope and responsibilities of the position, candidate’s work experience, education/training, key skills and internal parity, as well as location, market and business considerations when extending an offer. Kandu, Inc. is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.