Reimbursement Case Manager

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Valeris

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💊 Pharmaceuticals

🏥 Healthcare

🤝 B2B

Pharmaceuticals • Healthcare • B2B

Valeris is a fully integrated life sciences commercialization partner formed by the merger of PharmaCord and Mercalis. The company provides comprehensive solutions across the healthcare value chain to help life sciences companies bring products to market and improve patient access and adherence. Valeris offers data and strategic insights, patient support and access programs, and healthcare provider engagement tools, serving over 500 life sciences customers and supporting millions of patients. Headquartered in Morrisville, North Carolina and Jeffersonville, Indiana, Valeris focuses on enabling commercialization and patient-centric services for pharmaceutical and life sciences organizations.

📋 Description

• Provide inbound and outbound phone support as the primary contact for patients, caregivers and providers • Facilitate and monitor patients’ journeys through Patient Support Program services on behalf of a manufacturer • Handle day-to-day reimbursement services and interactions with healthcare insurance companies • Serve as an expert on reimbursement, co-pay, foundation assistance, PAP issues and other available support • Advocate for patients regarding eligibility, enrollment, reimbursement, affordability support and access to prescribed therapy • Establish relationships and maintain rapport with patients, payers and healthcare providers • Provide healthcare providers with detailed program and patient information • Verify insurance coverage, medical billing, reimbursement processes and access for complex pharmaceuticals • Evaluate 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 other materials • Document case status and background in the case management system • Communicate patient benefits and assist with prior authorization and appeals processes • 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 • Collaborate with the Program Manager regarding patient status, prescriber feedback, satisfaction and program effectiveness • Understand patients’ health and disease states • Maintain confidentiality, privacy, ethical conduct and adherence to SOPs • Perform additional assigned tasks or projects

🎯 Requirements

• 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 • Punctual, reliable with strong attendance record • Proficient with Microsoft products • Ability to type at least 35 words per minute with 97% accuracy preferred • Flexibility to travel as needed preferred • Must successfully complete a background check and, depending on the position, a drug screen

🏖️ Benefits

• 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 that encourages new ideas • Inclusive workplace and mission-driven culture • Background check and, depending on the position, drug screen in accordance with company standards