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Clinical Appeals Specialist (897386)

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CTC Resourcing Solutions

Our Client is an innovative R&D Biotech that has many agents at various trial phases and successfully achieved FDA Approval in 2015 for a new medical device within Oncology. They have a start up feel about them which creates a fast-paced, highly dynamic and entrepreneurial culture with an emphasis on being patient centric. They went “live” in 2015, so they are still setting and building up the structures and processes and are now in a role out phase for their new product. They are looking for a Clinical Appeals Specialist for a permanent position to be based in the Lucerne area.

Clinical Appeals Specialist (897386)

Purpose: support Clinical Appeals and the reimbursement teams for EMEA. You will be responsible for advocating to overturn all medical necessity denials through payer and case-specific appeals to maximize the probability of approvals by the payer. In addition you will support with retrieving documents, calling physicians and supporting in writing clinical appeals.

Kindly note there is a flexibility for the location, either Lucerne, CH or Munich, DE

Main Responsibilities

  • Work closely with Clinical Appeals team members and management to craft effective, high quality documents for reimbursement
  • Understand and navigate payer-specific medical necessity appeal processes
  • Draft clinical summaries and appeal letters for existing indication and potentially future indications as well
  • Review patient history and medical charts
  • Establish and maintain positive working relationships with internal and external partners
  • Ensure activities comply with the applicable Quality System requirements
  • All other duties or priorities assigned by management as needed

Qualifications and Experience

  • Medical background and work experience in social medicine, health insurance or social administration (Germany healthcare market MDK – experience is a huge advantage, MDK = Medizinischer Dienst für Krankenversicherungen)
  • Familiarity with the medical and oncology regulatory environment preferred
  • Familiarity with medical terminology, specific to oncology preferred
  • Experience with Microsoft Office required, experience with SAP or other ERP systems preferred
  • Excellent written and verbal communication skills
  • Demonstrated excellence in meeting customer/patient expectations
  • Effectiveness in understanding complex medical cases and resolving difficult situations
  • Ability to solve problems and set priorities
  • Self-motivation and willingness to make a difference in lives of cancer patients
  • Highly professional and ethical behaviour while contributing to the overall success of the company
  • Excellent German and medical vocabulary in speaking and writing
  • Good English in speaking and writing

Address

CTC Clinical Trial Consulting AG
Mr CTC Resourcing Solutions
Münchensteinerstrasse 41
4052 Basel
+41 61 695 88 66

Website http://www.ctcresourcing.com

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