Anna Kilbourn, PT, DPT — Clinical Appeals Specialist

Clinical Appeals Specialist — Anna Kilbourn

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Save 40% on Unlimited Medbridge CEUs with promo code TNCPT!
Save 40% on Unlimited Medbridge CEUs with promo code TNCPT!

This week’s spotlight is on Anna Kilbourn, PT, DPT, a Non-Clinical 101 graduate who is now Clinical Appeals Specialist for Myomo, Inc.!

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What is your full name, title, and company name for your current, primary role?

Anna Kilbourn, PT, DPT — Clinical Appeals Specialist for Myomo, Inc.

What additional roles do you currently have?

Freelance Health & Medical Writer

Where are you located?

I live in Michigan and work remotely.

Where did you go to PT school, and what year did you graduate?

University of Michigan, 2013.

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What did you do when you first finished school, and for how long?

I did travel PT. Then, I completed a post-doctoral orthopedic residency at Michigan Medicine MedSport for one year.

Next, I worked in outpatient rehab at ATI, treating mostly ortho/sports medicine with some neuro. While there, I was promoted to Director.

Following COVID-19 shutdowns, I did:

  • Concierge PT through Luna
  • Part-time outpatient at Henry Ford, which included a more neurological population
  • Home health

In what setting(s) did you work, and what types of patients did you treat?

I worked in the following settings:

  • Outpatient: ortho, sports, neuro, vestibular
  • Home health: ortho, neuro, cancer, geriatrics
  • Mobile concierge: ortho

What did you enjoy about your early roles? What didn’t you enjoy?

I enjoyed clinical care for many years and loved having a positive impact on my clients and my community. I also enjoyed mentoring new clinicians and teaching continuing ed courses, which was an incredibly rewarding experience. When I was promoted to Director of my clinic, I learned the business aspects of the role and felt proud of my accomplishments.

After a time, however, I wanted to have a different type of impact. I wanted to improve processes, build stronger systems, and have a wider reach in the healthcare system as a whole.

I kept running into the same problems in the clinical setting (insurance coverage, socioeconomic issues, technological inefficiencies, etc.) and wanted to be part of the solution.

When I found out about The Non-Clinical PT and all the non-traditional career options, I knew this was my next step!

What else have you done since then, prior to your current role?

In addition to my clinical work, I did PRN utilization review for a few years. This opened my eyes to how useful my skills could be outside of the clinic!

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When and why did you decide to do something non-clinical?

I was considering the idea in 2019 and really committed in late 2020/early 2021.

What are you doing these days?

My full-time position is Clinical Appeals Specialist at Myomo! In this role, I apply my clinical knowledge and help my department (Medical Affairs) build a reimbursement pathway for our medical device, the MyoPro.

The MyoPro is an extremely cool myoelectric orthotic that helps folks who have suffered from strokes (and other neurological disorders) with their upper extremity function.

I do a lot of individual case reviews and medical writing. Plus, I get to do special projects requiring other skills, such as literature reviews, policy analysis, and data analysis.

I also do a bit of freelance medical writing—though currently things have been busy in my life, so I haven’t taken on as many projects lately as I would like to. Hopefully, this is an area I can grow when I have more availability!

Are you still treating patients, or are you solely non-clinical?

Non-clinical all the way!

How long have you been in your current role?

Two years.

Did you get any special certifications or training along the way to help you get into your current role?

I took Non-Clinical 101, which was VERY helpful!! The course helped me define my skills and interests, so I knew what kind of position I was looking for.

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How did you find your clinical appeals specialist job? Did you apply or find it through a connection?

My job was posted in a group for transitioning clinicians, and I applied for it directly! I also reached out to the hiring manager to connect with her.

How have people reacted to you leaving patient care?

Many people in my life were honestly very confused about me leaving patient care. Ultimately, they supported my ability to make my own choices.

I think from the outside, PT can seem like a very ideal job, and I definitely felt that way about it, too, when I started!

Now that it has been a few years, it’s not such a big deal anymore, and everyone is used to my role. And my dog absolutely loves that I work remotely!

What’s a typical day or week in the life like for you? What types of tasks and responsibilities fill your time?

Our Medical Affairs Department is responsible for fighting for insurance coverage for folks who will benefit from our device. Currently, every case has to be individually argued for authorization consideration with the insurance company.

This process can be cumbersome, and it takes up the majority of my workload. I spend a lot of time reviewing medical documents (to make sure we have appropriate justification) and writing individual claims.

I have also worked on projects to analyze our reimbursement outcomes data and update our templates with current research literature. This helps us improve our processes to get more authorizations.

Finally, I stay up to date on any insurance or government regulations that might affect our ability to get coverage.

What are some of the rewards of your role? What are the biggest challenges?

The best reward in my role is when a patient gets a device after a tough fought case!

It’s incredible knowing that I was able to help improve the life of someone in need.

Our clients often have dense strokes and have already reached maximum benefit from PT/OT, so this is a life-changing opportunity for them to be able to perform ADLs again and have more independence in their life.

The biggest challenge is that—for medical devices (unlike pharmaceuticals)—the pathway to obtaining reimbursement can be unclear. We have to be very flexible and willing to tolerate ambiguity.

How did your clinical background prepare you for this role? Which skills transferred?

My specific position requires a clinical background due to the high amount of medical records that I review.

Beyond that requirement, it’s been amazing to me how well suited I was to join a startup culture. I credit my years as a therapist for making me prepared for this position.

As therapists, we are great problem-solvers, highly skilled at breaking down big issues and seeing stepwise solutions to get the outcomes we want. My ability to think analytically, adapt to process changes, and communicate effectively have been invaluable in my current role.

What type of person do you think would do well in your clinical appeals specialist role?

If you are interested in this type of work, you must be detail-oriented and be the kind of person who finds regulations and policies interesting—like a puzzle!

We are very quality-focused. It is important to have a very low error rate when sending documents to stakeholders. It is also very helpful to be passionate about technical and accurate writing. If you are someone who hates doing your clinical documentation, this job is not for you!

Does your organization hire PT, OT, or SLP professionals into non-clinical roles? If so, what type of roles?

Myomo has PTs and OTs on staff in a variety of roles, including medical affairs and clinical trainer roles that work more directly with patients and their local clinicians. We have also hired COTAs in the past for administrative and patient-facing roles.

Did you read any books, take any courses, or do anything special overall to get you where you are today?

I am someone who loves information, so I spent a long time reading everything I could get my hands on before making the leap.

It was really important to me to explore a lot of potential pathways and see all of my options before deciding on a direction.

I was also fortunate that I already had a little bit of experience doing utilization review as a side hustle, as well as a management position. I had dipped my toes into the non-clinical world long before I decided to make a full transition.

Some of my favorite books are:

What is a typical career path for someone in your clinical appeals specialist role?

My role is not a typical or easily described one, so the career path is not set in stone. The next step could be a leadership position, a senior writer role, a regulatory or policy position, or medical writing.

What is next for you? What are your high-level career aspirations?

This role has been such a great opportunity for me to grow, be supported, and to find my strengths. I’ve found that the two most exciting options for me are:

  • Process creation and improvement
  • Technical writing

Ideally, my high-level career aspirations are to move into a role that allows me to solve ambitious problems, develop strong processes and systems, and have a positive impact on the place I work.

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