Patient Engagement & Care Coordination Specialist

Valeris; Providence (RI); On-site; USD 50,000 - 70,000; Full time

Benefits offered by this job

Health plan

Vision and dental options

401(k) match

PTO & holidays

EAP services

Job summary

Valeris is seeking a patient services specialist to build trusted relationships with patients, manage inquiries, and communicate benefits and coverage options in line with healthcare regulations. You will guide patients through benefits investigations, offer education on treatment options, and coordinate with payers and providers to ensure access to needed therapies.

The role requires strong communication, empathy, and multitasking in a fast-paced setting, with an 8.5-hour shift between 8 am and

Qualifications

• Bachelor's degree strongly preferred or equivalent experience
• Customer service and healthcare industry experience strongly preferred
• Ability to work an 8.5-hour shift between 8 am to 9 pm, Monday to Friday
• Bi-lingual in English and Spanish or Chinese/Mandarin is a plus
• Commitment to the mission of care coordination
• Passionate, trustworthy, and empathetic when working with patients
• Good communication and interpersonal skills and ability to speak concisely to patients
• Flexible and adaptable in response to changing patient and healthcare providers' needs
• Professional telephone etiquette
• Self-awareness of your own emotions and the potential impact on others
• Basic computer knowledge
• Ability to multitask effectively
• Ability to recognize emotions and their effects
• Sureness about self-worth and capabilities
• Manage disruptive impulses
• Maintain standards of honesty and integrity
• Takes responsibility for performance
• Adapts and handles change with flexibility
• Is innovative and open to new ideas
• Achievement driven; constantly striving to improve or to meet a standard of excellence
• Aligns with the goals of the group or organization
• Ready to take initiative and act on opportunities
• Be optimistic and pursue goals persistently despite obstacles and setbacks
• Be service oriented and anticipate, recognize and meet the needs of others, including patients and care partners
• Positive attitude!

Responsibilities

• Build and maintain trusted relationships with patients by demonstrating proactive communication, delivering timely and accurate services, and showing a strong commitment to patient well-being.
• Ensure all interactions and relationship management practices comply with relevant healthcare laws and regulations.
• Demonstrate prior experience working with pharmacy benefit products and patients, or in immunology practices, to better understand patient needs and concerns.
• Conduct program welcome calls to patients, engaging them effectively and explaining available services and resources for their support.
• Utilize motivational interviewing techniques to actively involve patients in goal setting and achieving their healthcare objectives.
• Perform post Benefits Investigation calls to patients, clearly explaining coverage options to enhance patient understanding.
• Effectively handle all client inquiries that cannot be resolved through standard reporting processes.
• Address patient inquiries in accordance with applicable business rules, providing accurate and helpful information.
• Articulate complex reimbursement and billing information in a clear and concise manner to ensure patients comprehend their coverage benefits and financial responsibilities.
• Handle inbound calls as per the program-approved Frequently Asked Questions (FAQs).
• Exhibit excellent customer service skills, even in a fast-paced environment, and de-escalate any challenging situations in a professional and appropriate manner.
• Triage patients to appropriate internal or external resources, depending on their needs and requirements.
• Ensure proper documentation and recording of patient enrollment into the program, following established business rules.
• Provide patients with comprehensive information and education about products, including the course of treatment, insurance coverage benefits, anticipated out-of-pocket costs, potential financial assistance resources, and ongoing treatment support.
• Proactively manage assigned cases and tasks to maintain service levels and deliver excellent customer service to patients.
• Empower and inspire patients to take charge of their therapy plan as prescribed by their healthcare provider.
• Leverage electronic tools to identify benefits and payer coverage, conducting manual benefit investigations when necessary.
• Identify and communicate patients' plan benefit coverage, including any prior authorization, appeal, tier exception, or formulary exclusion requirements.
• Utilize electronic resources to obtain benefit coverage outcomes, and if needed, conduct outbound calls to payers and healthcare providers for follow-up.
• Support adherence services through the coordination of nurse follow-up, as applicable to the program.
• Identify and recommend peer support resources for patients to enhance their treatment experience.
• Coordinate the shipment of products through patient assistance programs and/or bridge programs from the PharmaCord pharmacy.
• Proactively communicate the need for re-verification of prior authorization or re-enrollment for patient assistance programs.
• Report adverse events, product complaints, special situation reports, and medical inquiries in accordance with established SOPs and Business Rules.
• Document all activities within the Lynk system to maintain accurate and up-to-date records, adhering to business requirements.

Skills

Customer service

Healthcare industry experience

Communication skills

Multitasking

Bilingual English/Spanish

Professional telephone etiquette

Empathy

Adaptability

Education

Bachelor's degree preferred

Job description

Valeris is seeking a patient services specialist to build trusted relationships with patients, manage inquiries, and communicate benefits and coverage options in line with healthcare regulations. You will guide patients through benefits investigations, offer education on treatment options, and coordinate with payers and providers to ensure access to needed therapies.

The role requires strong communication, empathy, and multitasking in a fast-paced setting, with an 8.5-hour shift between 8 am and