Note: The job is a remote job and is open to candidates in USA. Novocure is an oncology technology company focused on extending the lives of patients with aggressive cancers through its Tumor Treating Fields therapy. The Clinical Audit Response Specialist reviews payer audits, analyzes medical records, prepares appeals and clinical summaries, coordinates documentation, and supports compliance, accreditation readiness, and process improvement.
Responsibilities
- Review and respond to commercial and governmental payer audits in a timely, accurate, and compliant manner
- Analyze medical records to support audit responses, appeal arguments, clinical summaries, and documentation packages
- Coordinate with Reimbursement, Clinical, Revenue Operations, and other internal teams to obtain documentation needed for audit and appeal submissions
- Prepare, organize, and submit appeal packets, including clinical summaries, payer forms, medical records, prescriptions, proof of delivery, usage information, and other required documentation
- Support Medicare, Medicaid, commercial payer, prepayment, post-payment, RAC, and other audit or appeal activities as assigned
- Track audit activity, appeal deadlines, payer responses, outcomes, follow-up dates, and potential revenue impact in designated systems
- Identify denial trends, documentation gaps, compliance concerns, and operational risks, and communicate findings to management
- Help develop and improve audit response templates, appeal letters, workflows, policies, and procedures
- Support accreditation activities, survey readiness, evidence preparation, and responses to audit- or survey-related documentation requests
- Maintain confidential patient and company information in accordance with Novocure policies, HIPAA requirements, and applicable regulatory standards
- Build effective working relationships with internal stakeholders, external payers, auditors, and other business partners
- Participate in payer discussions, teleconference hearings, training, knowledge sharing, team projects, and process improvement initiatives as needed
Skills
- • Ability to review and interpret medical records, payer requests, denial rationale, coverage criteria, and supporting documentation
- • Strong written and verbal communication skills, including the ability to prepare clear, accurate, and persuasive appeal documentation
- • Strong analytical thinking, problem solving, prioritization, and attention to detail
- • Ability to manage multiple deadlines and assignments while maintaining accuracy and compliance
- • Ability to work independently and collaboratively in a fast-paced environment
- • Ability to identify trends, summarize findings, and communicate risks or opportunities to management
- • Familiarity with Microsoft Office products
- • Ability to maintain confidentiality and comply with company policies, security requirements, and regulatory expectations
- • Commitment to Novocure's patient-forward mission and values
- • Attendance may be required for onsite audits, accreditation surveys, hearings, or other business-critical activities
- • Ability to lift up to 20 pounds
- • Bachelor's degree and 3-5 years of experience in clinical, audit, reimbursement, or revenue cycle work
- • Clinical background, nursing degree, medical-record review experience, or comparable healthcare experience
- • Experience with payer audits, claims appeals, DME, medical device, oncology, revenue cycle, reimbursement, or clinical documentation
- • Knowledge of Medicare, Medicaid, commercial payer audit processes, appeal requirements, and timely filing expectations
- • Experience with SAP, CRM, payer portals, work queues, audit trackers, or similar systems
Benefits
- This position may also be eligible for an annual bonus
- This position may also be eligible for a restricted stock unit grant
- A full range of benefits
- Hybrid or remote work expectations may vary based on business needs
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