Executive Care Coordinator, Bilingual

This is a fully remote position, open to applicants in Arizona, +1 more state.

📋 Description

• Oversee the patient journey from initiation to resolution.

• Provide support to patients for accessing complex medications.

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

• Assist patients, caregivers, healthcare providers, specialty pharmacies, and other stakeholders through email and inbound/outbound calls.

• Clarify coverage options, eligibility, reimbursement support tools, and subsequent steps.

• Handle incoming calls and direct patients to the appropriate resources.

• Offer personalized case management and communicate details about benefit coverage.

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

• Liaise with payers and healthcare providers regarding outcomes of benefit coverage and submissions.

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

• Recognize peer-support resources and the need for re-enrollment or prior-authorization reverification.

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

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

• Create reports and analyses to uncover trends and areas for improvement.

• Adhere to laws, regulations, program procedures, HIPAA, SOPs, and training requirements.

• Undertake additional assigned tasks and projects.

⛳️ Requirements

• Proficient in both Spanish and English.

• A Bachelor's degree or higher is required; a preference for degrees in healthcare administration, social science, or related fields.

• In the absence of a degree, at least 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 needed.

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

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

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

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

• Exceptional attention to detail and organizational abilities.

• Capacity to prioritize tasks and operate efficiently in a fast-paced setting.

• Proficient written and verbal communication and interpersonal skills.

• Strong critical thinking and problem-solving skills.

• Must fulfill work-from-home criteria and meet business needs for remote eligibility.

• Preference for candidates who can type at least 35 words per minute with 97% accuracy.

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

🏝️ Benefits

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

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

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

• 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 and professional development.

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

• An inclusive workplace culture driven by mission.

• Preference for minimal travel flexibility.