Executive Care Coordinator

About the role

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions spanning the entire healthcare value chain. The company was formed by the merger of PharmaCord and Mercalis, and it revolutionizes the path from life sciences innovation to real-life impact to build a world where every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience, ensuring patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and a talented team, Valeris offers data and strategic insights, patient support services, and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris serves more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina, and Jeffersonville, Indiana.

Responsibilities

• Builds trusted relationships with patients, prescribers, and appropriate client stakeholders regarding reimbursement inquiries and challenges through proactive communication, timely and accurate execution of deliverables, and demonstrating relentless passion for helping patients.
• Manages all relationships in a manner that adheres to all relevant laws, regulations, program-specific operating procedures, and industry standards related to access and affordability, including HIPAA and insurance guidelines.
• Supports inbound and outbound calls to patients, caregivers, specialty pharmacies, and healthcare professionals.
• Performs post-Benefit Investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey.
• Manages all client inquiries as appropriate, such as case specific statuses.
• Manages HCP inquiries, as applicable, pursuant to business rules.
• Communicates with the client’s field teams in a way that remains compliant and adheres to ways of working protocols outlined between PharmaCord and the client teams.
• Manages inbound calls as directed by the program-approved FAQs.
• Provides personalized case management to patients and HCPs including outbound communication to HCPs, specialty pharmacies, and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine.
• Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed.
• Identifies and communicates patient’s plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions.
• Serves as a subject matter expert to internal team as required and appropriate.
• Utilizes electronic resources to obtain benefit coverage outcome and if needed, outbound call to payers and HCPs to follow up on proper submission and/or outcome.
• Coordinates nurse teach with nurse educators, as applicable to program.
• Supports adherence services as applicable to program.
• Identifies peer support resources for patients.
• Proactively communicates needs for reverification of prior authorization or re-enrollment.
• Identifies and reports adverse events, product complaints, special situation reports, and/or medical inquiries received in accordance with program operating procedures and the Business Rules.
• Documents all activities within the Lynk system, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals.
• Generates reports and analysis as needed to identify trends and opportunities for improvement in accordance with business requirements.
• Utilizes Valeris’ values as the driving force behind the team’s success.
• Ensures all SOPs are followed with consistency.
• Performs additional tasks or projects as assigned.

Qualifications

• Completion of Bachelor's degree (or higher) required.
• A degree in healthcare administration, social science, or similar related fields is strongly preferred.
• Minimum two years of experience in healthcare access delivery or management is strongly preferred.
• Five or more consecutive years of experience in relevant field will be considered in lieu of degree.
• Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist), or CCM in healthcare or social science (Certified Case Manager).
• Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
• Demonstrated examples of executing within guardrails recognizing urgency and consistently delivering patient-centric results.
• Excellent attention to detail and organizational skills.
• Ability to prioritize tasks and work efficiently in a fast-paced environment.
• Effective written and verbal communication and interpersonal skills, with the ability to interact professionally with diverse stakeholders.
• Demonstrates the ability to think critically and issue resolution.
• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.

Skills

• Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
• Excellent attention to detail and organizational skills.
• Ability to prioritize tasks and work efficiently in a fast-paced environment.
• Effective written and verbal communication and interpersonal skills, with the ability to interact professionally with diverse stakeholders.
• Demonstrates the ability to think critically and issue resolution.
• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.

Benefits

Full-time employees can expect medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs. Additional health support includes 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. 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.

Pay

Details of pay are not specified in the job posting.

Schedule

The 11:30 AM - 8 PM ET shift is required for this role.