Reimbursement Case Manager

Mercalis; United States; On-site; USD 50,000 - 70,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

401(k) Retirement Savings Plan with company match

Paid Time Off and Sick Leave

Opportunities for advancement

Job summary

Mercalis is seeking a Reimbursement Case Manager responsible for providing exceptional customer service to patients, caregivers, and providers.

This role involves facilitating the patient's journey through a Patient Support Program, ensuring they have access to necessary treatments while working with healthcare insurance companies.

Key responsibilities include verifying eligibility and program enrollment while supporting patients through the reimbursement process.

Qualifications

• Minimum of 4 years of call center or customer service experience.
• Ability to communicate effectively both orally and in writing.
• Knowledge of medical insurance terminology and healthcare billing.
• Strong organizational skills and ability to multi-task.

Responsibilities

• Provide inbound and outbound phone support as the primary contact for patients.
• Serve as an advocate for patients regarding eligibility and program enrollment.
• Maintain records in accordance with applicable standards and regulations.

Skills

Customer service

Communication

Problem-solving

Interpersonal skills

Attention to detail

Education

Associate or Bachelor’s degree

Tools

Microsoft products

Job description

Overview

THE SHIFTS FOR THIS ROLE ARE M-F 2:8:00am-5:00pm, 1:9:30am-6:30pm, 3:11:00am-8:00pm 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.

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

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.