What are the responsibilities and job description for the Claims Manager position at Octave?
Position: Denials & Appeals Manager
Reports to: Senior Director, Revenue Cycle Management
About Octave
At Octave Bioscience, we are transforming neurodegenerative disease care with cutting-edge diagnostics, digital solutions, and data-driven analytics. Our multidisciplinary team develops innovative tools that provide deep insights into disease progression, helping healthcare providers make more informed decisions while improving patient outcomes and reducing costs.
We are seeking a Denials & Appeals Manager to ensure efficient claim resolution, maximize reimbursement, and strengthen payer relationships, playing a key role in advancing access to our groundbreaking solutions.
KeyResponsibilities
At Octave, we are pioneering the future of neurodegenerative disease care. We offer a dynamic, fast-paced environment where your work directly contributes to advancing patient outcomes and transforming healthcare economics. If you are passionate about revenue cycle management, payer strategy, and making a meaningful impact, we'd love to hear from you!
Reports to: Senior Director, Revenue Cycle Management
About Octave
At Octave Bioscience, we are transforming neurodegenerative disease care with cutting-edge diagnostics, digital solutions, and data-driven analytics. Our multidisciplinary team develops innovative tools that provide deep insights into disease progression, helping healthcare providers make more informed decisions while improving patient outcomes and reducing costs.
We are seeking a Denials & Appeals Manager to ensure efficient claim resolution, maximize reimbursement, and strengthen payer relationships, playing a key role in advancing access to our groundbreaking solutions.
KeyResponsibilities
- Build a team of Denials and Appeals Specialists to identify, track, and resolve claim denials to maximize health plan reimbursement
- Partner with Business Analytics and Insights Lead to create payer tracking reports/dashboards to gather data, surface trends, and communicate health plan and revenue performance to key company stakeholders
- Review rejected claims to determine applicable claim corrections required for resubmission within the required filing time limits, as well as make recommendations for operational changes prior to claim submission to minimize rejection occurrences in the future
- Act as a liaison between RCM and Market Access to help pull through existing contracts within health plans, including developing and maintaining strategic relationships within each individual health plan, and collaborate on key non-contracted health plan strategies
- Research state and health plan specific rules and regulations on the process of overturning denials and submitting appeals
- Maintain current and in-depth knowledge of government and third-party payer billing regulations and guidelines
- Establish updates to workflow processes on the front end to circumvent claim issues prior to submission
- Collaborate with Legal to gather documentation necessary to pass health plan audits
At Octave, we are pioneering the future of neurodegenerative disease care. We offer a dynamic, fast-paced environment where your work directly contributes to advancing patient outcomes and transforming healthcare economics. If you are passionate about revenue cycle management, payer strategy, and making a meaningful impact, we'd love to hear from you!
