Reimbursement Case Manager

Valeris; Raleigh (NC); Vor Ort; USD 52.000 - 75.000; Vollzeit

Benefits dieser Stelle

Medical, dental, and vision plans

Telehealth services

401(k) match

Paid time off

Holidays

Zusammenfassung

Valeris is seeking a Reimbursement Case Manager to support patients, caregivers, and providers through the Patient Support Program. You will coordinate benefits, verify insurance coverage, assist with enrollment, and advocate for affordability to ensure access to prescribed therapies.

The role requires strong communication, knowledge of medical insurance terminology, and the ability to manage complex reimbursement processes in a fast-paced environment.

Qualifikationen

• Associate or Bachelor’s degree preferred; or a minimum of 4 years of call center or customer service experience
• Effective communication both oral and written
• Knowledge of medical insurance terminology and reimbursement/insurance
• Excellent problem-solving and decision-making skills
• Attention to detail and follow-through in communication with patients, providers and internal stakeholders
• Strong organizational skills
• Ability to multi-task and adapt to change while following Program Standards
• Strong interpersonal skills; ability to work independently or in a team
• Empathetic listening to interact effectively with patients and providers
• Punctual, reliable with strong attendance
• Proficient with Microsoft Office

Aufgaben

• Serve as primary contact for patients, caregivers, and providers via phone
• Coordinate resources and monitor patient needs in the Patient Support Program
• Interact with insurance companies to verify financial aspects of services
• Advocate for eligibility, enrollment, affordability, and access to therapy
• Establish relationships with patients, payers, and providers
• Explain benefits and assist in enrollment and billing processes
• Triage and escalate complex cases per SOPs
• Document status in case notes and track patient status with program manager
• Understand payer types and health states; maintain confidentiality
• Comply with SOPs and corporate policies
• Assist in program tasks and responsibilities as assigned

Kenntnisse

Communication

Insurance terminology

Problem solving

Attention to detail

Organizational skills

Multi-tasking

Interpersonal skills

Empathetic listening

Punctuality

Microsoft Office

Ausbildung

Associate or Bachelor’s degree preferred

4+ years in call center/customer service

Tools

Microsoft Office

Jobbeschreibung

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 www.valeris.com.

*** THE SHIFT FOR THESE ROLES WILL BE M-F 9A-6P EST ONLY ***

As a Reimbursement Case Manager, you provide inbound and outbound phone support and serve as the primary contact for patients, caregivers, and providers. You will facilitate a collaborative process that gauges, coordinates, and monitors patient needs and appropriately facilitate a patient’s journey utilizing services offered through the Patient Support Program on behalf of a manufacturer. The primary function is to provide unparalleled customer service to patients, caregivers and providers as a dedicated contact by coordinating resources, exchanging information and ensuring appropriate delivery of services. These services include handling the day-to-day activities within reimbursement services, such as daily interactions with healthcare insurance companies to verify the financial aspects of healthcare services to ensure patients have access to life saving treatments they need.

Key Responsibilities:

• Reimbursement Case Managers may be regionally aligned and will serve as an expert on reimbursement, co-pay, foundation assistance, PAP issues, and other forms of available support and will be responsible for handling patient and healthcare provider interactions
• Serve as an advocate to patients regarding eligibility requirements, program enrollment, reimbursement process, affordability support, and general access for prescribed therapy
• Establish relationships, develop trust, and maintain rapport with patients, payers and healthcare providers
• Serve as direct point of contact to health care providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient
• Serve as a resource for patients and healthcare professionals to verify insurance coverage, medical billing reimbursement process, and general access for complex pharmaceuticals
• Evaluate program enrollment forms for data integrity
• Responsible for insurance benefit investigations, and triage cases according to program standard operating procedures
• Follow program guidelines and elevate complex cases according to program policy, SOPs, Call Guides, and other program materials.
• Working case management system, documenting status/background in case notes, communicating patient benefits, assisting in the PA/Appeals process and like responsibilities
• Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD)
• Act as an assigned liaison to client contacts (e.g., regional contact for sales representatives), Program Management, other internal stakeholders and Healthcare Providers
• Maintain records in accordance with applicable standards and regulations to the programs/promotions
• Provide unparalleled customer service while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources
• Works with the Program Manager, on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction and program effectiveness
• Understand health and disease states of patients of the programs
• Maintains a high level of ethical conduct regarding confidentiality and privacy
• Help maintain team morale by consistently demonstrating positive attitude
• Utilize Valeris’ values as the driving force behind the team’s success
• On time adherence to training deadlines for all corporate policies and procedures
• Ensure all SOPs are followed with consistency
• Perform additional tasks or projects as assigned

Qualifications:

• Associate or Bachelor’s degree preferred; or a minimum of 4 years of call center or customer service experience with progressive levels of responsibility within a service driven environment
• Ability to communicate effectively both orally and in writing
• Knowledge of medical insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related experience
• Excellent problem-solving and decision-making skills required
• Attention to detail and committed follow through in communication with patients, providers and internal stakeholders
• Strong organizational skills
• Willing to work in a dynamic, fast paced environment and have the ability to multi-task and adapt to change while adhering to Program Standards
• Strong interpersonal skills, ability to work both independently and as part of a team, ability to jump in and help others as needed
• Empathetic listening skills in order to interact effectively with patients and providers
• Punctual, reliable with strong attendance record
• Proficient with Microsoft products
• Physical Demands & Work Environment

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy. 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.

Why Work for Valeris?

• 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
• Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
• 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
• A challenging, stimulating work environment that encourages new ideas
• Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
• A mission-driven, inclusive culture where your work makes a meaningful impact

Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice.

Our Commitment to Equal Opportunity

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. Valeris is proud to be an equal opportunity employer.