Reimbursement Case Manager

This is a fully remote position, open to applicants in North Carolina.

📋 Description

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

• Oversee and facilitate the patient experience throughout the Patient Support Program services.

• Coordinate resources, share information, and guarantee the proper delivery of services.

• Provide guidance on reimbursement, co-pay, foundation assistance, PAP issues, and other support options.

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

• Build and nurture relationships with patients, payers, and healthcare providers.

• Assist healthcare providers by supplying program and patient-related information.

• Confirm insurance coverage, medical billing, reimbursement procedures, 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.

• Adhere to program guidelines and escalate complex cases in line with policy, SOPs, Call Guides, and program documentation.

• Utilize the case management system to document case notes, communicate benefits, and assist with PA/Appeals processes.

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

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

• Maintain records in compliance with relevant standards and regulations.

• Act as a brand advocate and program representative while striving for quality outcomes.

• Communicate updates regarding patient status, prescriber feedback, satisfaction, and program effectiveness to the Program Manager.

• Uphold confidentiality and privacy standards.

• Meet training deadlines and adhere to all SOPs.

• Undertake additional assigned tasks or projects as needed.

⛳️ Requirements

• Preferred candidates should possess an Associate or Bachelor’s degree, or have at least 4 years of call center or customer service experience with increasing responsibilities.

• Strong oral and written communication skills are essential.

• Familiarity with medical insurance terminology, reimbursement processes, healthcare billing, physician office operations, health insurance processing, or similar experience is required.

• Excellent problem-solving and decision-making abilities are crucial.

• Meticulous attention to detail and a commitment to follow-through are necessary.

• Strong organizational skills are a must.

• Ability to thrive in a fast-paced, dynamic environment while multitasking and adapting to changes in accordance with Program Standards.

• Strong interpersonal abilities and the capacity to work both independently and collaboratively within a team.

• Empathetic listening skills are important.

• Punctuality, dependability, and a solid attendance record are expected.

• Proficiency in Microsoft products is necessary.

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

• Willingness to travel as needed is preferred.

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

🏝️ Benefits

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

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

• 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-funded Short-Term Disability coverage, with the option to purchase Long-Term Disability insurance.

• 401(k) Retirement Savings Plan featuring 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 development.

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

• An inclusive workplace with a mission-driven culture.

• Full-time employment benefits are provided.