Associate Market Access Case Manager (Contract)

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<p style="line-height:1.38;text-align:justify;"><span style="font-size:12px;">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. </span></p><p><span style="font-size:12px;">The Associate Market Access Case Manager supports the management of the prior authorization process for patients seeking insurance coverage for the IpsiHand Rehabilitation system. This full-time role is responsible for in-network gap exceptions, and negotiation of Single Case Agreements (SCAs) for patient-level device coverage; as well as, related follow-up responsibilities pertaining to pending prior authorizations. Associate Case Managers work with patients across all US states and territories, and over 100 different Medicare Advantage, Commercial, and Managed Medicaid health plans.</span></p><p><span style="font-size:14px;"><strong>What You’ll Do </strong></span></p><p><strong><span style="font-size:12px;">Single Case Agreements</span></strong></p><ul><li><span style="font-size:12px;">Submit applications to health plans and negotiate payment rates for Single Case Agreements.</span></li><li><span style="font-size:12px;">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</span></li></ul><span style="font-size:12px;"><strong>Follow-Up</strong></span><ul><li><span style="font-size:12px;">Communicate with payer representatives to confirm receipt of clinical documentation and identify missing information</span></li><li><span style="font-size:12px;">Document all payer communications, call reference numbers, outcomes, and next steps in case management systems</span></li><li><span style="font-size:12px;">Provide ongoing status updates to patients, providers, and internal stakeholders regarding insurance approvals and next steps</span></li><li><span style="font-size:12px;">Confirm authorization effective dates, approval durations, and renewal requirements to maintain continuity</span></li><li><span style="font-size:12px;">Monitor payer portals and follow up via phone/fax to ensure authorization requests are actively being processed</span></li><li><span style="font-size:12px;">Ensure timely follow-up on all open cases to meet service level expectations and improve patient outcomes</span></li></ul><h3><strong><span style="font-size:12px;">Collaboration</span></strong></h3><ul><li><span style="font-size:12px;">Partner cross-functionally with Commercial, Patient Intake, RCM and Clinical teams to share information, facilitate high-quality handoffs, and optimize patient experience</span></li><li><span style="font-size:12px;">Identify and share best practices with peers and leadership team to support continued improvement in organizational competencies</span></li><li><span style="font-size:12px;"> May be assigned additional responsibilities to meet departmental and organizational priorities</span></li></ul><h3><strong><span style="font-size:12px;">Compliance</span></strong></h3><ul><li><span style="font-size:12px;">Maintain up-to-date knowledge of payer requirements, clinical criteria, and regulatory changes that impact the prior authorization processes.</span></li><li><span style="font-size:12px;">Comply with all HIPAA guidelines, ensuring that all documentation and communications are handled securely and confidentially</span></li><li><span style="font-size:12px;">Recognize and report any product quality complaints in accordance with company SOPs</span></li></ul><p><span style="font-size:12px;"><strong>What You’ll Bring</strong></span></p><ul><li><span style="font-size:12px;">High School Diploma Or GED required. AA, BA, or BS desirable</span></li><li><span style="font-size:12px;">Minimum three years experience working in a healthcare environment (medical devices,insurance, or healthcare services)</span></li><li><span style="font-size:12px;">Experience in prior authorization submissions and appeals</span></li><li><span style="font-size:12px;">Competency working in SalesForce, Google Suite, and Microsoft Office</span></li><li><span style="font-size:12px;">Demonstrated customer service skills</span></li></ul><p><strong><span style="font-size:12px;">Skills and competencies</span></strong></p><ul><li><span style="font-size:12px;">Working understanding of market access, reimbursement, and payer landscapes</span></li><li><span style="font-size:12px;">Strong problem-solving and escalation management skills</span></li><li><span style="font-size:12px;">Advanced communication skills (providers,patients,payers)</span></li><li><span style="font-size:12px;">Strong communication skills (providers,patients,payers)</span></li><li><span style="font-size:12px;">Ability to prioritize workload and manage complex cases independently</span></li><li><span style="font-size:12px;">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</span></li></ul><p><span style="font-size:12px;"><strong>Other requirements</strong></span></p><ul><li><em><span style="font-size:12px;">Employment eligibility to work in the United States is required. The company does not sponsor employment visas for this position at this time.</span></em></li><li><span style="font-size:12px;">Ability to sit at a computer for extended periods and use standard office equipment.</span></li><li><span style="font-size:12px;">Ability to read and interpret clinical and insurance documents and communicate information clearly by phone and in writing.</span></li></ul><p><span style="font-size:12px;"><strong>Work Environment and Schedule</strong></span></p><p><span style="font-size:12px;">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</span></p><p><span style="font-size:14px;"><strong>What We Offer:</strong></span></p><ul><li><span style="font-size:12px;">Competitive Compensation ($25/Hr to $30/Hr DOE)</span></li></ul><p><span style="font-size:12px;">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.</span></p><p><span style="font-size:11px;">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.</span></p><p><br> </p>

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