Executive Care Coordinator

Valeris; Lexington (KY); Hybrid; USD 52,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, vision

HSA/FSA options

Telehealth

EAP programs

401(k) with match

Short-Term Disability

PTO & holidays

Career advancement

Diversity & Inclusion

Job summary

Valeris is seeking an Executive Care Coordinator to support patients through the complex process of obtaining coverage for prescribed medications. You will manage cases, educate stakeholders, and navigate reimbursement with a customer-focused approach.

You will work within a team to ensure timely, accurate documentation and adherence to program guidelines, HIPAA, and clinical best practices, while supporting travel as needed.

Qualifications

• Bachelor's degree required or higher.
• Healthcare administration degree preferred.
• Minimum two years in healthcare access delivery or management preferred.
• 5–10 years in insurance reimbursement or patient access considered in lieu of degree.
• Knowledge of ICD-10, CPT, HCPCS coding and insurance processes.
• Bi-lingual skills a plus.
• Remote work eligibility subject to criteria.

Responsibilities

• Educate patients and providers on coverage and program eligibility.
• Provide personalized case management and outbound communication.
• Assist with reimbursement challenges and eligibility determinations.
• Document all activities in the Lynk system with detailed records.
• Maintain HIPAA-compliant communications and procedures.
• Build trusted relationships with patients, prescribers, and client stakeholders.
• Handle inbound/outbound calls from patients, caregivers, pharmacies, and HCPs.

Skills

Communication skills

Healthcare knowledge

Insurance reimbursement

Patient support

HIPAA compliance

Bi-lingual (plus)

Education

Bachelor's degree

Healthcare administration degree preferred

Tools

Lynk system

Job description

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit

The 11:30 AM - 8 PM ET shift is required for this role.

When you join the team as an Executive Care Coordinator, you'll have the opportunity to make a difference in the lives of our patients each day as they look to you as part of their dedicated support team for helping them navigate the tricky process of getting access to their complex medication. You'll compassionately deliver an exceptional experience to many patients per day always remembering that every prescription or document belongs to a real person who is looking for thorough and efficient management of their records. You'll adjust your approach to their needs by communicating clearly, focusing on the accuracy of the details of their medical records, your mastery of the program requirements, and ensuring their prescriptions or cases are handled in a timely manner. An Executive Care Coordinator has the ability to translate knowledge into patient friendly language and education.

This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to navigate complex reimbursement processes.

The Executive Care Coordinator provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. The Executive Care Coordinator responsibilities include education on the access and reimbursement support tools available, advising HCPs and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on Payor processes and procedures.

Relationship Management

Builds trusted relationships with patients, prescribers, and appropriate client stakeholders regarding reimbursement inquiries and challenges through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients.

Manages all relationships in a manner that adheres to all relevant laws, regulations, program-specific operating procedures and industry standards related to access and affordability, including HIPAA and insurance guidelines.

Managed through call/contact center structure, this role supports inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals.

Manages all client inquiries as appropriate, such as case specific statuses.

Manages HCP inquiries, as applicable, pursuant to business rules.

All communications with the client’s field teams will remain compliant and adhere to ways of working protocols outlined between PharmaCord and the client teams.

Inbound Call Management

Manages inbound calls as directed by the program-approved FAQs

Personalized Case Management

Provides personalized case management to patients and HCPs including outbound communication to HCPs, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine. All communications for case management will follow the guidelines set forth for the program and only provide information publicly available and/or outlined in the patient insert.

Supports adherence services as applicable to program.

Identifies peer support resources for patients.

Identifies and reports adverse events, product complaints, special situation reports and/or medical inquiries received in accordance with program operating procedures and the Business Rules.

Documents all activities within the Lynk system, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals.

On time adherence to training deadlines for all corporate policies and procedures

Perform additional tasks or projects as assigned

Completion of Bachelor's degree (or higher) required

A degree in healthcare administration, social science or similar related fields is strongly preferred.

• ~ Minimum two years of experience in healthcare access delivery or management is strongly preferred.
• ~5-10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education experience will be considered in lieu of degree.
• ~ Will consider other certifications and five or more consecutive years of experience in relevant field. Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager).
• ~ Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
• ~ Effective written and verbal communication and interpersonal skills, with the ability to interact professionally with diverse stakeholders.
• ~ Bi-lingual skills are a plus.
• ~ Remote work eligibility is subject to all work from home criteria met and based on business need

Although very minimal, flexibility to travel as needed is preferred.

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

We’re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:

• ~ Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
• ~ Additional health support, including telehealth and Employee Assistance Program (EAP) services
• ~ Company match on Health Savings Account contributions
• ~ Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
• ~401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
• ~ Paid Time Off (PTO) and Sick Leave to support work-life balance
• ~ Team members receive nine paid holidays plus two floating holidays
• ~ Opportunities for advancement in a company that supports personal and professional growth
• ~ Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
• ~ At Valeris, we don’t just accept difference – we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community.