Executive Care Coordinator

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

📋 Description

• Manage the patient journey from initiation through to closure.

• Conduct benefit investigations and monitor prior authorizations and denial appeals.

• Support patients, caregivers, healthcare providers, specialty pharmacies, and other parties through resolutions via email and inbound/outbound calls.

• Provide education on access and reimbursement support tools, benefits, and program eligibility.

• Educate healthcare provider offices about payer processes and procedures.

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

• Handle incoming calls in accordance with program-approved FAQs and direct patients to suitable resources.

• Address inquiries from clients and healthcare providers.

• Offer personalized case management and communicate the next steps for securing medication coverage and access.

• Identify and relay coverage requirements, including prior authorization, appeals, tier exceptions, and formulary exclusions.

• Utilize electronic tools and manual inquiries to assess benefits and payer coverage.

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

• Coordinate nurse education sessions with nurse educators and support adherence services.

• Identify peer support resources and proactively communicate any re-verification or re-enrollment needs.

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

• Document reimbursement activities in the Lynk system, including claims status, payments, and appeals.

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

• Adhere to SOPs, corporate policies, and program operating procedures.

• Undertake additional assigned tasks and projects.

⛳️ Requirements

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

• A degree in healthcare administration, social science, or a related field is strongly preferred.

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

• Between 5 to 10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education may be considered in lieu of a degree.

• Additional certifications and five or more consecutive years of relevant experience may be considered; examples include PACS, CHES, or CCM.

• Strong comprehension of medical terminology and coding systems, including ICD-10, CPT, and HCPCS.

• Familiarity with insurance processes, HIPAA, and Medicare/Medicaid guidelines.

• Ability to think critically and resolve issues effectively.

• Exceptional attention to detail and organizational abilities.

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

• Proficient written and verbal communication skills and strong interpersonal abilities.

• Professional interaction with a diverse range of stakeholders is essential.

• Bilingual skills are advantageous.

• Must fulfill all work-from-home criteria; remote eligibility is contingent on business needs.

• Ability to type a minimum of 35 words per minute with 97% accuracy is preferred.

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

🏝️ 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 matching on Health Savings Account contributions.

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

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

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

• Paid Time Off (PTO) and Sick Leave.

• Nine paid holidays plus two floating holidays.

• Opportunities for career advancement and personal as well as professional development.

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

• An inclusive workplace culture driven by a mission.

• Minimal travel flexibility is preferred.