Commercial Appeals Team Lead

Koya is always looking for curious and passionate individuals who want to join a fast- paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. We offer a base + bonus compensation package, and a competitive benefits program.
Description

Job SummaryThe Commercial Appeals Team Lead is responsible for overseeing the daily operations of the commercial appeals team, ensuring accurate and timely appeal submissions. This role serves as a subject matter expert in appeal guidelines, supports staff development, and ensures adherence to regulatory, compliance, and quality requirements. Additionally, this position is responsible for securing reimbursement from third-party payers by developing persuasive appeal letters and navigating complex insurance processes. This role involves reviewing clinical documentation, educating payers on product benefits, and supporting patients through the appeals process to ensure optimal coverage outcomes.This role reports to the Appeals Manager within the Reimbursement Operations Department. The role is full time, exempt and will work remotely.Essential Duties and ResponsibilitiesThe essential functions include, but are not limited to the following:● Serve as the first-line resources for Appeals Specialists regarding payer requirements, workflow questions, and complex or escalated cases.● Support onboarding and training of new Appeals Specialists, including shadowing,competency checks, and reinforcement of best practices.● Identity workflow gaps, recurring issues, or payer-specific challenges and escalate recommendations for process improvement.● Partner with Manager, Appeals to track team performance metrics and contribute to performance evaluations.● Draft persuasive appeal letters to third-party payers using clinical documentation● Review medical records and develop appeal strategies based on payer guidelines and case strength● Advocate for patients denied coverage and educate payers on product benefits● Collaborate with internal departments to ensure accurate processing of patient orders and payer decisions● Communicate with patients regarding appeal status, required attestations, product use, and financial concerns● Update case records and tasks in Salesforce; ensure accuracy and timeliness● Maintain compliance with HIPAA and all regulatory requirements● Support the development of internal workflows and best practices● Ensure accuracy while meeting productivity and quality standardsMinimum QualificationsEducation, Experience and Training● High school diploma required; Associate’s or Bachelor's degree preferred● Minimum 3 years of experience in appeals and reimbursement processes● Background in medical devices, healthcare reimbursement, or related fieldKnowledge, Skills, and Abilities● Strong leadership and team development skills● Strong knowledge of insurance processes and third-party payer requirements● Excellent written and verbal communication skills, including appeal and patient correspondence● High attention to detail with strong analytical and problem-solving abilities● Ability to work independently and collaboratively in a fast-paced environment● Proficient in navigating payer portals and Salesforce● Demonstrated ability to multitask, prioritize, and meet deadlines under pressure● High attention to detail with strong analytical skills, including appeal and patient correspondence● Ability to work independently and in collaboration with a team● Proficient in navigating payer portals and Salesforce● Demonstrated ability to multitask, prioritize, and meet deadlines under pressureCore Competencies● Communication & cultural competence● Initiative & critical thinking● Flexibility & adaptability● Planning & organization● Teamwork & collaborationTools and TechnologyGoogle Suite, Microsoft Office, Adobe, Salesforce CRMPhysical Functions and Work EnvironmentThe physical functions described here are representative of those that must be met byan employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.NoteThis job description in no way states or implies that these are the only duties to beperformed by the employee(s) incumbent in this position. Employees will be requiredto follow any other job-related instructions and to perform any other job-related dutiesrequested by any Koya manager authorized to provide instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice.All duties and responsibilities are essential functions and requirements and are subjectto possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.Koya Medical, Inc. is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.#LI-REMOTE

About the Company

Koya Medical, a privately held company founded in 2018, is a transformative healthcare company developing breakthrough treatments for venous diseases and lymphedema to enable joint contractions, patient mobility, and personalized care that is unavailable with traditional compression therapy.

Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun.

We offer a base + bonus compensation package, and a competitive benefits program.




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