Reimbursement Case Manager

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions spanning the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. The company provides data, 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. Headquarters are located in Morrisville, North Carolina and Jeffersonville, Indiana.

About the role

As a Reimbursement Case Manager, you provide inbound and outbound phone support and serve as the primary contact for patients, caregivers, and providers. You will 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. The primary function is to provide unparalleled customer service to patients, caregivers, and providers by coordinating resources, exchanging information, and ensuring appropriate delivery of services.

Responsibilities

• Serve as an expert on reimbursement, co-pay, foundation assistance, PAP issues, and other forms of available support; handle patient and healthcare provider interactions
• Act 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 healthcare providers for ongoing support and relationship development by acquiring and delivering detailed program and patient information
• Verify insurance coverage, medical billing, reimbursement processes, and general access for complex pharmaceuticals for patients and healthcare professionals
• Evaluate program enrollment forms for data integrity
• Conduct 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
• Manage case documentation in a case management system, communicate patient benefits, and assist in the PA/Appeals process
• Understand and explain benefits offered by all payer types including private/commercial and government (e.g., Medicare, Medicaid, VA, and DOD)
• Act as a 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
• Provide unparalleled customer service while serving as a brand advocate and program representative; commit to achieving quality outcomes and appropriate use of resources
• Work with the Program Manager to maintain open lines of communication and share awareness regarding patient status, prescriber feedback, and program effectiveness
• Understand health and disease states of patients within 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
• Adhere to training deadlines for all corporate policies and procedures
• Ensure all SOPs are followed consistently
• 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, or health insurance processing experience
• Excellent problem-solving and decision-making skills
• Attention to detail and committed follow-through in communication with patients, providers, and internal stakeholders
• Strong organizational skills
• Ability to work in a dynamic, fast-paced environment, 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 willingness to assist others as needed
• Empathetic listening skills to interact effectively with patients and providers
• Punctual, reliable, with a strong attendance record
• Proficient with Microsoft products
• Ability to type at least 35 words per minute with 97% accuracy
• Flexibility to travel as needed (minimal)

Physical Demands & Work Environment

• Regularly required to talk or hear
• Frequently required to sit for long periods, use hands to type, handle or feel, and reach with hands and arms
• Operates in a professional office environment
• Routinely uses standard office equipment such as computers, phones, and photocopiers

Schedule

Monday through Friday, 11:00 AM to 8:00 PM EST only.

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 annual earnings (minimum $50,000, maximum $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 to support work-life balance
• Nine paid holidays plus two floating holidays
• Opportunities for advancement in a company that supports personal and professional growth
• Challenging, stimulating work environment that encourages new ideas
• Mission-driven, inclusive culture where your work makes a meaningful impact