Reimbursement Specialist

About the role

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions to improve patient access to critical medications. This role involves providing in-depth knowledge of client programs by working directly with patients, healthcare providers, and insurance companies to answer inquiries, process service requests, assess benefits coverage, and manage through barriers in a compliant manner.

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.
• Coverage determination summary.
• Coordination of prior authorizations based on payer guidelines and in compliance with law, regulation or guidance.
• 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

• Service minded; focus on recognizing and meeting the needs of others (especially patients and care partners).
• Commitment to honesty and integrity.
• Professionalism and a strong sense of proper business and customer service etiquette.
• Clear verbal and written communication skills.
• Accountability for results.
• Planning and prioritizing tasks and strong attention to detail.
• Utilize Valeris’ values as the driving force behind the team’s success.
• On time adherence to training deadlines for all corporate policies and procedures.
• Ensure all SOPs are followed with consistency.
• 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.