Benefit Specialist (9:30am - 6pm shift)

Key Responsibilities

• 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.
• Cordination 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.

Qualifications

• 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.

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.

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.
• 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.
• A mission-driven, inclusive culture where your work makes a meaningful impact.