Reimbursement Specialist

Valeris, Inc.; Jeffersonville (IN); On-site; USD 52,000 - 65,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

HSA- and FSA-eligible options

401(k) Retirement Savings Plan with 5%

Paid Time Off and holidays

Company match on Health Savings

Job summary

Valeris, Inc. is seeking a Reimbursement Specialist to support patients, providers, and insurers. You will verify benefits, coordinate prior authorizations, and review patient assistance enrollments in a fast-paced, compliant environment.

This role emphasizes patient access to therapy, adherence to SOPs, and strong customer service. Office-based work with potential minimal travel is expected.

Qualifications

• Bachelor's degree strongly preferred or equivalent experience.
• 6 months customer service experience preferred.
• Payer benefits experience (reimbursement, prior authorization) or healthcare industry exposure preferred.
• Bilingual ability is a plus.

Responsibilities

• Benefit verification for major medical and pharmacy plans.
• Coordinate prior authorizations per payer guidelines.
• Review patient assistance enrollment forms and determine eligibility.
• Answer inbound calls and assist customers; provide guidance or warm transfer as needed.
• Use internal systems to process claims and keep workflows moving.

Skills

Customer service

Communication skills

Team collaboration

Payer benefits experience

Attention to detail

Education

Bachelor's degree

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. The Reimbursement Specialist works in a dynamic and compassionate customer service role providing telephonic and web-based, where applicable, customer service support.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 concernsEffectively 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 successOn time adherence to training deadlines for all corporate policies and proceduresEnsure all SOPs are followed with consistencyPerform additional tasks or projects as assignedQualifications:Service minded; focus on recognizing and meeting the needs of others (especially patients and care partners)Ability to handle personal health information with confidentialityCommitment to honesty and integrityProfessionalism and a strong sense of proper business and customer service etiquetteClear verbal and written communication skillsAccountability for resultsAbility to plan and prioritize tasks and strong attention to detailProficient emotional intelligence (ability to recognize emotions and their effects)Ability to manage disruptive impulses and handle potentially stressful customer interactionsProficient computer skillsAdaptability to changePersonal initiative and commitment to team and organizational goalsAbility to work effectively within a teamA positive attitude!Bachelor's degree strongly preferred or equivalent experience required; completion of a high school diploma or GED is required6 months customer service experience, payer benefits experience (reimbursement, prior authorization, etc.), healthcare industry experience or healthcare related certification, license, or equivalent coursework is strongly preferredBilingual is a plusThis is an office-based position, the ability to sit for extended periods of time is necessaryAlthough very minimal, flexibility to travel as needed is preferredPhysical Demands & Work EnvironmentWhile 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 costsAdditional health support, including telehealth and Employee Assistance Program (EAP) servicesCompany match on Health Savings Account contributionsFree Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vestingPaid Time Off (PTO) and Sick Leave to support work-life balanceTeam members receive nine paid holidays plus two floating holidaysOpportunities for advancement in a company that supports personal and professional growthA challenging, stimulating work environment that encourages new ideasWork for a company that values diversity and makes deliberate efforts to create an inclusive workplaceA mission-driven, inclusive culture where your work makes a meaningful impactAny 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 OpportunityAt 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.