Executive Care Coordinator

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

📋 Description

• Oversee the entire patient journey from start to finish.

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

• Support patients, caregivers, healthcare providers, specialty pharmacies, and other stakeholders in resolving issues via email, inbound/outbound calls, and Lynk technology.

• Clarify coverage options and outline next steps following benefits investigations.

• Address inquiries from clients and healthcare providers.

• Establish trusted relationships through proactive, timely, and precise communication.

• Direct patients to suitable internal or external resources when necessary.

• Offer personalized case management and relay information on benefit coverage and subsequent steps.

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

• Reach out to payers and healthcare providers to follow up on submissions and results.

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

• Identify peer-support resources and communicate any reverification or re-enrollment requirements.

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

• Log reimbursement activities, claims status, payments, and appeals in Lynk.

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

• Act as a subject matter expert for the internal team.

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

• Undertake additional tasks or projects as assigned.

⛳️ Requirements

• A Bachelor's degree (or higher) is required; a degree in healthcare administration, social science, or a related field is strongly preferred.

• If a degree is not held, a minimum of five 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 necessary.

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

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

• Strong knowledge of medical terminology and coding systems (ICD-10, CPT, HCPCS).

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

• Capability to meet work-from-home criteria, depending on business needs.

• Preferred typing speed of at least 35 words per minute with 97% accuracy.

• Exceptional attention to detail and organizational skills.

• Ability to prioritize tasks and work effectively in a fast-paced setting.

• Proficient written and verbal communication and interpersonal skills.

• Strong critical-thinking and issue-resolution skills.

• Bilingual abilities are a plus.

• Successful completion of a background check and, if applicable, a drug screen is required.

🏝️ Benefits

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

• Telehealth services and Employee Assistance Program (EAP) access.

• Company contributions matching Health Savings Account deposits.

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

• Company-sponsored 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 plus two floating holidays.

• Opportunities for career advancement and personal development.

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

• An inclusive workplace with a mission-driven culture.

• Preferred flexibility to travel as necessary.