Reimbursement Specialist

About the role

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions spanning the entire healthcare value chain. We revolutionize the path from life sciences innovation to real-life impact to build a world where every patient gets the care they need. We work on behalf of life sciences companies to improve the patient experience, ensuring patients can access and adhere to critical medications. Backed by industry expertise, a deep commitment to patient care, and exceptional talent, Valeris offers data and strategic insights, patient support services, and healthcare provider engagement tools to help life sciences companies commercialize new products.

Responsibilities

• Provide inbound and outbound phone support and serve as the primary contact for patients, caregivers, and providers.
• Facilitate a collaborative process that gauges, coordinates, and monitors patient needs and appropriately facilitates a patient’s journey utilizing services offered through the Patient Support Program on behalf of a manufacturer.
• Provide unparalleled customer service to patients, caregivers, and providers by coordinating resources, exchanging information, and ensuring appropriate delivery of services.
• Handle the day-to-day activities within reimbursement services, such as daily interactions with healthcare insurance companies to verify the financial aspects of healthcare services to ensure patients have access to life-saving treatments.
• Be an expert on reimbursement, co-pay, foundation assistance, PAP issues, and other forms of available support, and be responsible for handling patient and healthcare provider interactions.
• Establish relationships, develop trust, and maintain rapport with patients, payers, and healthcare providers.
• Serve as a direct point of contact to healthcare providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient.
• Evaluate program enrollment forms for data integrity.
• Investigate insurance benefit claims, triage cases according to program standard operating procedures, and follow program guidelines and SOPs.
• Document status and background in case notes, communicate patient benefits, assist in the PA/Appeals process, and perform other case management tasks.
• Communicate with patients and providers to verify insurance coverage, medical billing, reimbursement processes, and general access for complex pharmaceuticals.
• Work with the Program Manager to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction, and program effectiveness.
• Understand health and disease states of patients of 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.
• Follow program SOPs with consistency.

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.
• Ability to communicate effectively both orally and in writing.
• 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, ability to jump in and help others as needed.
• Empathetic listening skills in order to interact effectively with patients and providers.
• Punctuality, reliability with strong attendance record.
• Proficiency with Microsoft products.