Reimbursement Case Manager

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 10%

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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 • Handle day-to-day reimbursement services and interact with healthcare insurance companies to verify financial aspects of healthcare services • Advise patients on eligibility requirements, program enrollment, reimbursement processes, affordability support, and access to prescribed therapy • Establish 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 • Use the case management system, document case notes, communicate patient benefits, and assist with prior authorization and appeals processes • Explain benefits for private/commercial and government payer types, 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 • Work with the Program Manager to communicate patient status, prescriber feedback, satisfaction, and program effectiveness • Maintain confidentiality and privacy and follow all SOPs • Complete training deadlines and 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 • 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 • Punctuality, reliability, and strong attendance record • Proficient 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

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

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