Reimbursement Case Manager

🕒 Agosto 20

🐎 Kentucky, North Carolina – Remoto

🐎 Kentucky – Remote 🌲 North Carolina – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 10%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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Valeris

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

💊 Farmacêutico

🏥 Saúde

🤝 B2B

Pharmaceuticals • Healthcare • B2B

A Valeris é um parceiro totalmente integrado de comercialização em ciências da vida, formada pela fusão da PharmaCord e da Mercalis. A empresa oferece soluções abrangentes ao longo da cadeia de valor da saúde para ajudar as empresas de ciências da vida a levar produtos ao mercado e melhorar o acesso e a adesão dos pacientes. Valeris oferece dados e insights estratégicos, programas de suporte e acesso a pacientes e ferramentas de engajamento de prestadores de saúde, atendendo a mais de 500 clientes de ciências da vida e apoiando milhões de pacientes. Com sedes em Morrisville, Carolina do Norte, e Jeffersonville, Indiana, a Valeris se concentra em viabilizar a comercialização e serviços centrados no paciente para organizações farmacêuticas e de ciências da vida.

Descrição

• Provide inbound and outbound phone support as the primary contact for patients, caregivers, and providers • Coordinate and monitor patient needs and facilitate patient journeys through Patient Support Program services • Handle daily reimbursement-service activities and interact with healthcare insurance companies • Serve as an advocate regarding eligibility, enrollment, reimbursement, affordability support, and access to prescribed therapy • Build relationships and maintain rapport with patients, payers, and healthcare providers • Support healthcare providers with program and patient information • Verify insurance coverage, medical billing, reimbursement processes, and access for complex pharmaceuticals • Evaluate program enrollment forms for data integrity • Conduct insurance benefit investigations and triage cases according to standard operating procedures • Follow program guidelines and escalate complex cases according to policies, SOPs, Call Guides, and program materials • Operate the case management system, document case notes, communicate patient benefits, and assist with prior authorization and appeals • Explain benefits offered by private/commercial and government payers, including Medicare, Medicaid, VA, and DOD • Liaise with client contacts, Program Management, internal stakeholders, and healthcare providers • Maintain records according to applicable standards and regulations • Serve as a customer-service representative and brand advocate while pursuing quality outcomes • Communicate with the Program Manager regarding patient status, prescriber feedback, satisfaction, and program effectiveness • Maintain knowledge of patient health and disease states • Maintain confidentiality and privacy • Complete training and follow corporate policies and SOPs • Perform additional assigned tasks or projects

🎯 Requisitos

• 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 • Attention to detail and committed follow-through in communication with patients, providers, and internal stakeholders • Strong organizational skills • Ability to work in a dynamic, fast-paced environment, multitask, and adapt to change while adhering to Program Standards • Strong interpersonal skills and ability to work independently and as part of a team • Empathetic listening skills for effective interaction with patients and providers • Punctuality, reliability, and strong attendance record • Proficiency with Microsoft products • Prefer candidates able to type at least 35 words per minute with 97% accuracy • Flexibility to travel as needed preferred • Successful completion of a background check and, depending on the position, a drug screen

🏖️ Benefícios

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs • Telehealth and Employee Assistance Program (EAP) services • Company match on Health Savings Account contributions • Free Basic Life and AD&D coverage equal to 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% contributed, with immediate vesting • Paid Time Off (PTO) and Sick Leave • Nine paid holidays plus two floating holidays • Opportunities for advancement and personal and professional growth • Challenging, stimulating work environment encouraging new ideas • Inclusive workplace and mission-driven culture • Background check and, depending on position, drug screen contingent upon employment offer