Patient Navigator

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

📋 Description

• Act as the primary point of contact, providing individualized case management for patients, caregivers, and healthcare providers.

• Conduct benefit investigations, monitor prior authorizations, and facilitate appeals.

• Inform patients, healthcare providers, and stakeholders about access and reimbursement processes, payer policies, and patient assistance and copay programs.

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

• Coordinate and collaborate with client field teams in accordance with business rules and guidelines.

• Clearly communicate benefit coverage options and next steps in the patient journey using accessible, patient-friendly language.

• Utilize electronic tools to conduct benefit investigations and obtain payer coverage for prescribed treatments.

• Ensure all activities are compliant with healthcare laws, regulations, HIPAA, insurance guidelines, and standard operating procedures.

• Identify and escalate adverse events, product complaints, and special situation reports as necessary.

• Keep detailed and accurate records of all activities within the Mercalis system.

• Support adherence services, including patient education and nurse-teaching coordination as required.

• Engage in team meetings and participate in ongoing training.

• Uphold Valeris values, corporate policies, procedures, and standard operating procedures.

• Undertake additional tasks or projects as assigned.

⛳️ Requirements

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

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

• At least two (2) years of experience in healthcare access delivery or management is strongly preferred.

• Five (5) to ten (10) years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education may be considered in place of a degree.

• Additional certifications and five (5) or more consecutive years of relevant experience may be taken into account.

• Certifications such as PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist), or CCM (Certified Case Manager) in healthcare or social science are examples of qualifications.

• A solid understanding of medical terminology and ICD-10, CPT, and HCPCS coding systems is essential.

• Familiarity with insurance processes is required.

• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines, is necessary.

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

• Bilingual or multilingual skills are a plus.

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

• Willingness to travel as needed is preferred.

• Capability to work in a professional office environment utilizing computers, phones, and photocopiers.

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

🏝️ Benefits

• Comprehensive medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing towards premium costs.

• Access to Telehealth services and the Employee Assistance Program (EAP).

• Company matching on Health Savings Account contributions.

• Complimentary Basic Life and AD&D coverage equivalent 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 provisions.

• Nine paid holidays plus two floating holidays.

• Opportunities for advancement along with personal and professional growth.

• A challenging and stimulating work environment that fosters innovation.

• An inclusive workplace with a mission-driven culture.

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