Executive Care Coordinator

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

📋 Description

• Take ownership of the patient journey from start to finish.

• Conduct benefit investigations while tracking prior authorizations and appeal denials.

• Support patients and stakeholders through resolution via email, inbound/outbound calls, and Lynk technology.

• Offer expertise on insurance coverage, access issues, and reimbursement challenges.

• Provide education to patients, caregivers, healthcare providers, and HCP offices regarding benefits, eligibility, payer processes, and available support tools.

• Develop trusted relationships with patients, prescribers, specialty pharmacies, healthcare professionals, and client stakeholders.

• Manage inbound calls following program-approved FAQs and direct patients to the appropriate resources.

• Deliver personalized case management while communicating benefit coverage and next steps.

• Identify requirements for prior authorization, appeals, tier exceptions, and formulary exclusions.

• Follow up with payers and HCPs concerning submissions and their outcomes.

• Coordinate nurse teaching with nurse educators and support adherence services as necessary.

• Recognize peer support resources and communicate needs for reverification or re-enrollment.

• Identify and report adverse events, product complaints, special situation reports, and medical inquiries.

• Document reimbursement activities, claims statuses, payments, and appeals in Lynk.

• Generate reports and analyses to identify trends and opportunities for improvement.

• Adhere to company values, meet training deadlines, follow SOPs, and complete assigned projects.

⛳️ Requirements

• A Bachelor's degree (or higher) is required.

• Alternatively, five or more years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is required.

• At least two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is mandatory.

• A minimum of two years of experience in healthcare access delivery or management is strongly preferred.

• A solid understanding of medical terminology and coding systems (ICD-10, CPT, HCPCS) is essential.

• A strong grasp of insurance processes is necessary.

• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines, is required.

• Excellent attention to detail and organizational abilities are a must.

• Capability to prioritize tasks and work efficiently in a fast-paced environment is essential.

• Strong written and verbal communication skills, along with effective interpersonal skills, are required.

• Ability to think critically and resolve issues is necessary.

• Bilingual skills are a plus.

• Typing speed of at least 35 words per minute with 97% accuracy is preferred.

• Willingness to travel as needed is preferred.

• Remote work eligibility is subject to work-from-home criteria and business requirements.

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

🏝️ Benefits

• Comprehensive medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing to premium costs.

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

• Company matching on Health Savings Account contributions.

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

• Company-paid Short-Term Disability coverage, with the 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 along with two floating holidays.

• Opportunities for career advancement and personal and professional development.

• A challenging and stimulating work environment that fosters new ideas.

• An inclusive workplace with a mission-driven culture.

• Background check and, based on the position, a drug screen in accordance with company standards.