Executive Care Coordinator, Bilingual

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

📋 Description

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

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

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

• Clearly communicate coverage options and next steps to patients and healthcare providers.

• Handle inquiries from patients, prescribers, healthcare providers, clients, specialty pharmacies, and payers.

• Direct patients to internal or external resources as needed.

• Deliver personalized case management and relay information regarding benefit coverage and access next steps.

• Recognize prior authorization, appeal, tier exception, and formulary exclusion requirements.

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

• Organize nurse education sessions 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.

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

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

• Act as a subject matter expert while adhering to SOPs, business rules, training deadlines, and compliance requirements.

⛳️ Requirements

• Fluency in both Spanish and English is required.

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

• In the absence of a degree, a minimum of five years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is necessary.

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

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

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

• Familiarity with HIPAA and Medicare/Medicaid guidelines is required.

• Exceptional attention to detail and organizational skills are necessary.

• Capability to prioritize tasks and work effectively in a fast-paced environment is important.

• Strong written and verbal communication and interpersonal skills are essential.

• Ability to think critically and resolve issues efficiently is necessary.

• Must meet work-from-home criteria, subject to business needs.

• Candidates should be able to type at least 35 words per minute with 97% accuracy.

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

🏝️ 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 contributions on 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-paid Short-Term Disability coverage, with the 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 benefits.

• Nine paid holidays plus two floating holidays.

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

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

• An inclusive workplace and mission-driven culture.

• Preference for candidates who can accommodate minimal travel flexibility.