Reimbursement Case Manager

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

📋 Description

• Act as the main contact for patients, caregivers, and providers, offering inbound and outbound phone support.

• Oversee and guide patients’ experiences through the Patient Support Program services for a manufacturer.

• Manage daily reimbursement services and liaise with healthcare insurance companies.

• Serve as a knowledgeable resource on reimbursement, co-pay, foundation assistance, PAP issues, and other support options available.

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

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

• Supply healthcare providers with comprehensive program and patient information.

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

• Assess enrollment forms for data accuracy.

• Conduct insurance benefit investigations and triage cases according to established standard operating procedures.

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

• Record case status and background in the case management system.

• Communicate patient benefits and assist with prior authorization and appeals processes.

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

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

• Maintain records in accordance with relevant standards and regulations.

• Collaborate with the Program Manager regarding patient status, prescriber feedback, satisfaction, and program efficiency.

• Comprehend patients’ health and disease conditions.

• Uphold confidentiality, privacy, ethical conduct, and compliance with SOPs.

• Perform additional assigned tasks or projects.

⛳️ Requirements

• Preferred: Associate or Bachelor’s degree; or a minimum of 4 years of call center or customer service experience with increasing responsibilities in a service-oriented setting.

• Exceptional oral and written communication skills.

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

• Strong problem-solving and decision-making abilities.

• Keen attention to detail and dedicated follow-through in communications with patients, providers, and internal stakeholders.

• Excellent organizational skills.

• Capability to thrive in a dynamic, fast-paced environment, multitasking and adapting to changes while following Program Standards.

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

• Empathetic listening abilities.

• Punctual, dependable, with a strong attendance record.

• Proficient in Microsoft products.

• Preferred: Ability to type at least 35 words per minute with 97% accuracy.

• Preferred: Willingness to travel as necessary.

• Must successfully pass a background check and, depending on the role, a drug screening.

🏝️ Benefits

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

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

• Company matching contributions on Health Savings Account deposits.

• Complimentary Basic Life and AD&D coverage equal to annual earnings, with a minimum of $50,000 and a maximum of $300,000.

• Company-sponsored 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.

• Nine paid holidays plus two floating holidays.

• Opportunities for career advancement and personal and professional development.

• Engaging and stimulating work environment that fosters new ideas.

• Inclusive workplace and mission-driven culture.

• Background check and, depending on the position, drug screening in line with company standards.