Reimbursement Case Manager

About the role

Valeris is a life sciences commercialization partner that provides comprehensive solutions to improve patient access to critical medications. Headquartered in Morrisville, North Carolina and Jeffersonville, Indiana, Valeris works with over 500 life sciences customers to enhance their commercialization efforts.

Responsibilities

• Provide inbound and outbound phone support to patients, caregivers, and providers.
• Facilitate a collaborative process to gauge, coordinate, and monitor patient needs.
• Ensure appropriate delivery of services through the Patient Support Program on behalf of a manufacturer.
• Handle the day-to-day activities within reimbursement services, including verifying the financial aspects of healthcare services.
• Communicate with healthcare insurance companies to verify the financial aspects of healthcare services.
• Evaluate program enrollment forms for data integrity.
• Investigate insurance benefit claims 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.
• Document status/background in case notes, communicate patient benefits, assist in the PA/Appeals process, and perform other responsibilities within the call management system.
• Understand and explain benefits offered by various payer types, including private/commercial and government (Medicare, Medicaid, VA, and DOD).
• Act as an assigned liaison to client contacts, Program Management, and healthcare providers.
• Maintain records in accordance with applicable standards and regulations.
• Work with the Program Manager to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction, and program effectiveness.
• Understand the health and disease states of patients involved in the programs.
• Maintain a high level of ethical conduct regarding confidentiality and privacy.
• Help maintain team morale by consistently demonstrating a positive attitude.
• Utilize Valeris’ values as the driving force behind the team’s success.
• Ensure all SOPs are followed with consistency.
• Perform additional tasks or projects as assigned.

Qualifications

• Ace 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.
• 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.
• Willingness 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, and the ability to jump in and help others as needed.
• Empathetic listening skills in order to interact effectively with patients and providers.
• Punctuality, reliability, and strong attendance record.
• Proficiency with Microsoft products.

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, 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.
• 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.