Care Coordinator

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Take ownership of patient cases from initiation to completion.

• Conduct benefit investigations and handle prior authorizations/denial appeals.

• Assess financial eligibility for assistance programs.

• Guide patients, callers, and stakeholders to resolution through email, inbound/outbound calls, and Lynk technology.

• Establish and nurture trusted relationships with patients, prescribers, and client stakeholders.

• Execute program welcome calls and follow up post-benefits-investigation.

• Address client and healthcare professional inquiries in line with business rules.

• Manage incoming calls and direct patients to appropriate resources.

• Deliver individualized case management and convey benefit coverage along with next steps.

• Identify benefits and payer coverage using both electronic tools and manual investigations.

• Articulate coverage details, prior authorizations, appeals, tier exceptions, and formulary exclusions.

• Follow up with payers and healthcare providers regarding submissions and outcomes.

• Coordinate nurse education and adherence services as applicable.

• Identify peer support resources.

• Organize product shipments through patient assistance and bridge programs.

• Communicate needs for prior authorization reverification and patient assistance re-enrollment.

• Report adverse events, product complaints, special situation reports, and medical inquiries following SOPs and business rules.

• Document activities in the PharmaCord Lynk system.

• Adhere to corporate policies, SOPs, and training deadlines.

• Undertake additional assigned tasks or projects.

⛳️ Requirements

• A Bachelor’s degree is strongly preferred, or equivalent experience is required.

• Customer service and healthcare industry experience is preferred but not mandatory.

• Must be able to work an 8.5-hour shift between 8 am and 9 pm, Monday to Friday.

• Bilingual skills in Spanish and English are advantageous.

• Eligibility for remote work is contingent upon meeting all work-from-home criteria and business needs.

• Attention to detail is essential.

• Professional telephone etiquette is required.

• Basic computer skills are necessary.

• Ability to multitask effectively is crucial.

• Clear and concise communication skills are important.

• Candidates should be able to type at least 35 words per minute with 97% accuracy, preferred.

• Flexibility to travel as needed is preferred.

• Successful completion of a background check and, depending on the position, a drug screen is necessary.

🏝️ Benefits

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing towards premium costs.

• Access to Telehealth services and Employee Assistance Program (EAP).

• Company match on Health Savings Account contributions.

• Complimentary Basic Life and AD&D coverage equivalent to annual earnings, with a minimum of $50,000 and a maximum of $300,000.

• Company-paid Short-Term Disability coverage, with an option to purchase Long-Term Disability.

• 401(k) Retirement Savings Plan featuring a 100% match on the first 5% contributed, with immediate vesting.

• Paid Time Off (PTO) and Sick Leave.

• Nine paid holidays and two floating holidays.

• Opportunities for advancement and both personal and professional growth.

• A challenging, stimulating work environment that promotes new ideas.

• An inclusive workplace with a mission-driven culture.

• Background check and, depending on the position, drug screen required as a condition of employment.