Executive Care Coordinator, Bilingual

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

📋 Description

• Provide an outstanding patient experience while assisting patients in navigating access to complex medications.

• Oversee each patient's journey from start to finish.

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

• Support patients, callers, healthcare providers, caregivers, specialty pharmacies, and stakeholders through resolution via email, inbound/outbound calls, and Lynk technology.

• Clarify coverage options, next steps, benefits, and eligibility for programs.

• Educate healthcare provider offices on payer processes and procedures.

• Establish and maintain trusted relationships with patients, prescribers, and client stakeholders.

• Triage patients to internal or external resources as necessary.

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

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

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

• Coordinate nurse education with nurse educators and assist with adherence services as needed.

• Recognize peer support resources and proactively communicate the need for reverification or re-enrollment.

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

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

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

• Adhere to corporate policies, SOPs, program rules, and training deadlines.

• Execute additional assigned tasks or projects.

⛳️ Requirements

• Bilingual in Spanish and English.

• A Bachelor’s degree or higher is required.

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

• In lieu of a degree, over 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 will be taken into account.

• Proficient knowledge of medical terminology and coding systems, including ICD-10, CPT, and HCPCS.

• Strong understanding of insurance processes.

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

• Exceptional attention to detail and organizational abilities.

• Capability to prioritize tasks and operate efficiently in a dynamic environment.

• Proficient written and verbal communication skills and interpersonal abilities.

• Ability to think critically and resolve issues effectively.

• Typing speed of at least 35 words per minute with 97% accuracy is preferred.

• Eligibility for remote work is subject to work-from-home criteria and business needs.

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

🏝️ Benefits

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

• Telehealth and Employee Assistance Program (EAP) services.

• Company match on Health Savings Account contributions.

• Complimentary Basic Life and AD&D coverage equal to your 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% you contribute, with immediate vesting.

• Paid Time Off (PTO) and Sick Leave.

• Nine paid holidays plus two floating holidays.

• Opportunities for advancement and personal and professional development.

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

• An inclusive workplace and mission-driven culture.

• Minimal travel required as needed.