Reimbursement Case Manager

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

📋 Description

• Act as the main point of contact for patients, caregivers, and providers by providing inbound and outbound phone support.

• Coordinate and oversee patient needs while guiding them through the services offered by the Patient Support Program.

• Manage daily reimbursement service tasks and liaise with healthcare insurance companies.

• Advocate for patients concerning eligibility, enrollment, reimbursement, affordability support, and access to prescribed therapies.

• Foster relationships and maintain rapport with patients, payers, and healthcare professionals.

• Assist healthcare providers with information regarding programs and patients.

• Verify insurance coverage, medical billing, reimbursement processes, and access for complex pharmaceuticals.

• Assess program enrollment forms to ensure data integrity.

• Conduct investigations into insurance benefits and triage cases following standard operating procedures.

• Follow program guidelines and escalate complex cases in accordance with policies, SOPs, Call Guides, and program materials.

• Utilize the case management system to document case notes, communicate patient benefits, and assist with prior authorizations and appeals.

• Clarify benefits provided by private/commercial and government payers, including Medicare, Medicaid, VA, and DOD.

• Collaborate with client contacts, Program Management, internal stakeholders, and healthcare providers.

• Maintain records in compliance with applicable standards and regulations.

• Serve as a representative of customer service and a brand advocate while striving for high-quality outcomes.

• Update the Program Manager on patient status, prescriber feedback, satisfaction, and overall program effectiveness.

• Keep abreast of patient health and disease states.

• Uphold confidentiality and privacy standards.

• Complete all training and adhere to corporate policies and SOPs.

• Execute additional assigned tasks or projects as necessary.

⛳️ Requirements

• An Associate or Bachelor’s degree is preferred, or at least 4 years of call center or customer service experience with increasing responsibilities in a service-oriented setting.

• Strong oral and written communication skills.

• Familiarity with medical insurance terminology, reimbursement/insurance processes, healthcare billing, physician office operations, or related experience.

• Exceptional problem-solving and decision-making abilities.

• Keen attention to detail and a commitment to follow-through in communication with patients, providers, and internal stakeholders.

• Excellent organizational skills.

• Capacity to operate in a dynamic, fast-paced environment while multitasking and adapting to change in accordance with Program Standards.

• Strong interpersonal skills, with the ability to work independently and collaboratively within a team.

• Empathetic listening skills for effective engagement with patients and providers.

• Punctual, reliable, and possess a strong attendance record.

• Proficiency in Microsoft products.

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

• Flexibility to travel as required is preferred.

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

🏝️ Benefits

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

• Nine paid holidays plus two floating holidays.

• Opportunities for career advancement and personal and professional development.

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

• An inclusive workplace and mission-driven culture.

• Background check and, depending on position, drug screen contingent upon employment offer.