Senior Clinical Audit Response Specialist

Senior Clinical Audit Response Specialist

 

JOB SUMMARY:

 

The Senior Clinical Audit Response Specialist is responsible for managing and analyzing all medical content and supporting the Reimbursement team with appeals to minimize the financial burden for patients. Focus on review and response to commercial and governmental payer audit activity. Additional responsibilities include, preparing for and representing Novocure in all aspects of the payer audit process and if appropriate participate in teleconference hearings, ensuring that timeliness guidelines are met, and appeals are handled in compliance with regulatory requirements of CMS and other agencies. The Senior Clinical Audit Response Specialist will be responsible for assisting in training and development of new and tenured team members. This position will build and manage relationships with internal and external partners, including collaboration with and supporting other Revenue Operations functional teams.

This is a full-time, exempt position reporting to Director, Payer Contracting and Relationship Management based in Portsmouth, NH.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

·        Serve as the primary point of contact for all payer-initiated audits; manage the process end-to-end, ensuring internal and external timelines are met

·        Analyze medical records to provide accurate information according to policies and procedures

·        Enhance appeal methodologies through data analysis, aiming to overturn denials effectively

·        Utilize problem solving and creative thinking in order to prepare clinical summaries and appeal letters, with the ability to review and edit templates as needed

·        Conduct intricate data analysis to offer valuable insights for informed business decisions

·        Manage and maintain confidential information, ensuring it is handled securely and in compliance with the Novocure's policies and procedures

·        Efficiently manage multiple tasks and deadlines, ensuring that all assignments are completed accurately and in a timely manner

·        Provide accurate and thorough testimony for teleconference hearings, including ALJ and State Fair Hearings as needed to support the Clinical Audit Response team

·        Support the training and development of both new and experienced team members

·        Establish and maintain positive working relationships with internal and external partners

·        Support internal and external audits as needed 

·        Lead and support team projects as assigned

·        Fulfill any additional duties or directives provided by management

 

QUALIFICATIONS/KNOWLEDGE:

·        7-10 years in a medical device or DME company and/or neuro oncology background, preferred

·        Active RN license required; Bachelor’s or Master’s degree preferred

·        Exceptional proficiency in written and verbal communication

·        Thorough understanding of government and commercial appeals process

·        Comprehensive knowledge of medical and oncology regulatory environments

·        Proficiency in oncology-specific terminology

·        Ability to adhere to company policies and procedures and follow directions

·        Proficiency in analytical thinking, problem-solving an