Reimbursement Specialist

Valeris, Inc.; Indiana (PA); Hybrid; USD 36,000 - 54,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

Telehealth services

Health Savings Account (HSA)

FSA options

401(k) with employer match

Paid time off

Paid holidays

Job summary

Valeris, Inc. is seeking a Benefits Specialist to support patients, providers, and insurers. You will verify benefits, assist with prior authorizations, and review enrollment documents to determine eligibility for programs.

The role emphasizes patient-focused service, compliance, and effective use of our PharmaCord Lynk system to keep claims moving and cases progressing.

Qualifications

• Minimum 6 months customer service experience or healthcare-related experience preferred
• Experience with payer benefits (reimbursement, prior authorization) is a plus
• Bilingual skills are a plus

Responsibilities

• Verify patient benefits for major medical and pharmacy plans.
• Coordinate prior authorizations per payer guidelines.
• Review patient assistance enrollment forms and determine eligibility.
• Answer inbound calls and provide accurate information or route to specialists.
• Identify missing or incorrect information in program service requests.
• Report adverse events/product complaints per SOP.
• Use PharmaCord Lynk to process claims and maintain workflow.
• Communicate case status with medical practices and sales representatives.
• Provide consultative guidance to overcome obstacles to paid therapy.
• Maintain compliance with SOPs and company policies.

Skills

Customer service

Communication skills

Confidentiality

Honesty and integrity

Professionalism

Teamwork

Attention to detail

Emotional intelligence

Adaptability

Positive attitude

Education

Bachelor’s degree strongly preferred or equivalent experience

High school diploma or GED required

Tools

PharmaCord Lynk

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 www.valeris.com.

A typical day in this role will include providing in-depth knowledge of our client programs by working directly with patients, healthcare providers, and insurance companies to answer inquiries, process service requests, assess benefits coverage, and manage through barriers, in a compliant manner, that stand in the way of patients and their access to therapy.

Key Responsibilities

• Benefit Verification: Performing patient level benefits verifications as applicable for all major medical and pharmacy benefits plans. Completion of the template forms that provide patient level benefits Coverage Determination Summary.
• Coordination of prior authorizations based on payer guidelines and in compliance with law, regulation or guidance.
• Patient Assistance: Review of patient assistance enrollment forms and any supporting documentation to assess patient eligibility for participation as per SOPs and program guidelines. Determination of patient’s eligibility based upon program criteria for qualification. Communicating the patient’s eligibility to the patient, healthcare provider, and/or consignment pharmacy.
• Answer and assist inbound callers through resolution utilizing answers to frequently asked questions or by warm transferring callers to other appropriate individuals. Actively listen to each customer, assess needs, and respond with demonstrated patience and courtesy.
• Review and identification of information that is missing and/or incorrect within program service requests/program applications.
• Reporting of Adverse Events/ Product Complaint inquiries received in accordance with SOP and good manufacturer practices. Provides timely feedback to the company regarding service failures or customer concerns.
• Effectively uses our internal technology platform, PharmaCord Lynk, to complete claims processing and keep workflows moving.
• Communicate with key medical practice accounts, sales representatives regarding the status of cases.
• Provide consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy.
• Benefits Specialists are expected to be patient focused and committed to providing the highest quality customer service all while maintaining a sense of compliance and commitment to abiding by company policies and procedures. 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

• Service minded; focus on recognizing and meeting the needs of others (especially patients and care partners)
• Ability to handle personal health information with confidentiality
• Commitment to honesty and integrity
• Professionalism and a strong sense of proper business and customer service etiquette
• Clear verbal and written communication skills
• Accountability for results
• Ability to plan and prioritize tasks and strong attention to detail
• Proficient emotional intelligence (ability to recognize emotions and their effects)
• Ability to manage disruptive impulses and handle potentially stressful customer interactions
• Proficient computer skills
• Adaptability to change
• Personal initiative and commitment to team and organizational goals
• Ability to work effectively within a team
• A positive attitude!
• Bachelor's degree strongly preferred or equivalent experience required
• completion of a high school diploma or GED is required
• 6 months customer service experience, payer benefits experience (reimbursement, prior authorization, etc.), healthcare industry experience or healthcare related certification, license, or equivalent coursework is strongly preferred
• Bilingual is a plus

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?

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
• 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.

A Name With Purpose.

Inspired by those who work each day to transform access and enhance lives, our name emerges from the root valor: to be bold, brave, determined, be well, have worth. It speaks to integrity, simplicity, strength, and principled action.

Valeris merges this with vision and an intention to redefine value at every step in the patient journey. We honor the science. We unlock the value. We do it with vision. We are Valeris. Purpose: Valeris represents measurable business impact through healthcare innovation that transforms lives. We combine cutting-edge technology with healthcare expertise to tackle challenges in access, affordability, and quality of care. Success means improving patient outcomes - everything we do is anchored in the value of improving human lives.

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.