Reimbursement Specialist

Valeris; Louisville (KY); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health plans

Telehealth benefits

401(k) with match

Paid time off

Job summary

Valeris is seeking a Benefits Specialist to support patients, providers, and insurers with benefits verification, enrollment, and eligibility determination in a fast-paced, office-based role in Louisville. You will use PharmaCord Lynk to process claims and resolve access barriers while maintaining strict confidentiality.

Ideal candidates have 6 months of customer service or payer benefits experience and a bachelor's degree or equivalent.

Qualifications

• Service minded; focus on recognizing and meeting the needs of others (patients and care partners)
• Ability to handle personal health information with confidentiality
• Commitment to honesty and integrity
• Professionalism and customer service etiquette
• Clear verbal and written communication skills
• Accountability for results
• Ability to plan and prioritize tasks with attention to detail
• Adaptability to change
• Teamwork and collaboration
• Bachelor's degree strongly preferred or equivalent experience

Responsibilities

• Provide in-depth knowledge of client programs by working with patients, healthcare providers, and insurance companies
• Answer inquiries, process service requests, assess benefits coverage, and manage barriers to access
• Perform benefits verifications for major medical and pharmacy plans
• Coordinate prior authorizations per payer guidelines and SOPs
• Review patient assistance enrollment forms and assess eligibility
• Communicate eligibility to patients, providers, and consignment pharmacies
• Assist inbound callers and transfer to appropriate contacts
• Use PharmaCord Lynk to complete claims processing and maintain workflows
• Support key medical practice accounts and sales teams with case status and consultative advice
• Adhere to SOPs and company policies; participate in training and tasks as assigned
• Maintain patient-focused service while upholding compliance and accuracy

Skills

Customer service

Payer benefits

Healthcare industry knowledge

Communication skills

Education

Bachelor's degree or equivalent experience

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. The Benefits Specialist works in a dynamic and compassionate customer service role providing telephonic and web-based, where applicable, customer service support.

Key Responsibilities

The responsibilities include, but are not limited to the following:

• 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

The candidate must possess the following personal attributes:

• 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
• This is an office-based position, the ability to sit for extended periods of time is necessary
• Although very minimal, flexibility to travel as needed is preferred

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

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.