Executive Care Coordinator

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

📋 Description

• Take ownership of the patient experience from start to finish

• Conduct benefit investigations and monitor prior authorizations and denial appeals

• Support patients and stakeholders in resolving issues via email, inbound/outbound calls, and Lynk technology

• Provide guidance to patients, caregivers, healthcare providers, and clients regarding insurance coverage, benefits, eligibility, and reimbursement challenges

• Educate healthcare provider offices about payer processes and protocols

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

• Handle inbound calls and direct patients to appropriate resources

• Perform post-benefits-investigation calls to explain coverage options and subsequent steps

• Address client and healthcare provider inquiries in accordance with business regulations

• Deliver personalized case management and outline next steps for securing medication coverage and access

• Identify plan benefit coverage, prior authorizations, appeals, tier exceptions, and formulary exclusions

• Follow up with payers and healthcare providers regarding submissions and results

• Coordinate nurse education sessions with nurse educators and provide adherence support

• Identify peer-support resources and communicate any prior-authorization reverification or re-enrollment needs

• Report adverse events, product complaints, special situation reports, and medical inquiries as per established procedures

• Document reimbursement activities, claims status, payments, and appeals within Lynk

• Create reports and analyses to spot trends and opportunities for improvement

• Adhere to corporate policies, Standard Operating Procedures (SOPs), training deadlines, and assigned projects

⛳️ Requirements

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

• If no degree, 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 experience in a relevant field may be considered

• Strong knowledge of medical terminology, ICD-10, CPT, HCPCS, and insurance processes is required

• Familiarity with healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines is essential

• Exceptional attention to detail and organizational skills are required

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

• Strong written and verbal communication skills, along with interpersonal abilities

• Critical thinking and problem-solving skills are a must

• Bilingual abilities are an asset

• Candidates should be able to type a minimum of 35 words per minute with 97% accuracy

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

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

🏝️ Benefits

• Medical, dental, and vision insurance 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 equal to annual earnings, with a minimum of $50,000 and a maximum of $300,000

• Company-funded 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 plus two floating holidays

• Opportunities for career advancement and personal growth

• A challenging and stimulating work environment that encourages innovative ideas

• An inclusive workplace with a mission-driven culture

• Preference for minimal travel flexibility