Reimbursement Case Manager

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

📋 Description

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

• Facilitate and oversee the patient journey through the Patient Support Program services.

• Manage daily reimbursement services and engage with healthcare insurance companies to confirm financial details of healthcare services.

• Guide patients regarding eligibility criteria, program enrollment, reimbursement procedures, affordability support, and access to prescribed therapies.

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

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

• Confirm insurance coverage, medical billing, reimbursement procedures, and access for complex pharmaceuticals.

• Assess program enrollment forms for accuracy and data integrity.

• Conduct insurance benefit investigations and prioritize cases in accordance with standard operating procedures.

• Adhere to program guidelines and escalate complex cases as per policies, SOPs, Call Guides, and program documentation.

• Utilize the case management system to document case notes, communicate patient benefits, and aid in prior authorization and appeals processes.

• Clarify benefits for private/commercial and government payer types, 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.

• Partner with the Program Manager to relay patient status, prescriber feedback, satisfaction levels, and program effectiveness.

• Uphold confidentiality and privacy, adhering to all SOPs.

• Meet training deadlines and undertake additional assigned tasks or projects.

⛳️ Requirements

• Preferred Associate or Bachelor’s degree; or at least 4 years of call center or customer service experience with increasing responsibilities in a service-focused environment.

• Strong oral and written communication skills.

• Familiarity with medical insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing, or similar experience.

• Exceptional problem-solving and decision-making abilities.

• Detail-oriented with a commitment to follow-through.

• Strong organizational capabilities.

• Ability to thrive in a dynamic, fast-paced setting, managing multiple tasks and adapting to change while upholding Program Standards.

• Strong interpersonal skills and the ability to work independently as well as collaboratively in a team.

• Empathetic listening skills.

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

• Proficient in Microsoft Office products.

• Preference for candidates capable of typing at least 35 words per minute with 97% accuracy.

• Preferred flexibility to travel as necessary.

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

🏝️ Benefits

• Medical, dental, and vision insurance plans, including HSA and FSA-eligible options, 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 insurance coverage equal 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.

• 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 in addition to two floating holidays.

• Opportunities for career advancement and both personal and professional growth.

• Engaging and stimulating work environment that encourages innovative ideas.

• Inclusive workplace and mission-driven culture.

• Background checks and, depending on the position, drug screening in accordance with company standards.