Reimbursement Case Manager

🕒 3 days ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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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 and serve as the primary contact for patients, caregivers, and providers • Facilitate a collaborative process that gauges, coordinates, and monitors patient needs and appropriately facilitate a patient’s journey utilizing services offered through the Patient Support Program on behalf of a manufacturer • Provide unparalleled customer service to patients, caregivers and providers as a dedicated contact by coordinating resources, exchanging information and ensuring appropriate delivery of services • Handle the day-to-day activities within reimbursement services, such as daily interactions with healthcare insurance companies to verify the financial aspects of healthcare services to ensure patients have access to life saving treatments they need • Serve as an advocate to patients regarding eligibility requirements, program enrollment, reimbursement process, affordability support, and general access for prescribed therapy • Establish relationships, develop trust, and maintain rapport with patients, payers and healthcare providers • Serve as direct point of contact to health care providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient • Evaluate program enrollment forms for data integrity • Responsible for insurance benefit investigations, and triage cases according to program standard operating procedures • Follow program guidelines and escalate complex cases according to program policy, SOPs, Call Guides, and other program materials • Working case management system, documenting status/background in case notes, communicating patient benefits, assisting in the PA/Appeals process and like responsibilities • Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD) • Act as an assigned liaison to client contacts (e.g., regional contact for sales representatives), Program Management, other internal stakeholders and Healthcare Providers • Maintain records in accordance with applicable standards and regulations to the programs/promotions • Provide unparalleled customer service while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources • Work with the Program Manager, on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction and program effectiveness • Understand health and disease states of patients of the programs • Maintain a high level of ethical conduct regarding confidentiality and privacy • Help maintain team morale by consistently demonstrating positive attitude • 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

🎯 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 required • Attention to detail and committed follow through in communication with patients, providers and internal stakeholders • Strong organizational skills • Willing to work in a dynamic, fast paced environment and have the ability to multi-task and adapt to change while adhering to Program Standards • Strong interpersonal skills, ability to work both independently and as part of a team, ability to jump in and help others as needed • Empathetic listening skills in order to interact effectively with patients and providers • Punctual, reliable with strong attendance record • Proficient with Microsoft products

🏖️ Benefits

• 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