Reimbursement Specialist

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

📋 Description

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

• Coordinate and oversee patient needs throughout their journey in the Patient Support Program.

• Manage daily activities related to reimbursement services.

• Engage with healthcare insurance companies to confirm the financial details of healthcare services.

• Provide guidance to patients regarding eligibility criteria, program enrollment, reimbursement procedures, affordability support, and access to therapy.

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

• Offer continuous support and program information to healthcare providers.

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

• Assess program enrollment forms for accuracy and integrity of data.

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

• Adhere to program guidelines and escalate intricate cases according to policies, SOPs, Call Guides, and program documentation.

• Keep case records updated and document status and background information 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.

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

• Maintain records in compliance with relevant standards and regulations.

• Act as a brand advocate and program representative, ensuring quality customer service and positive outcomes.

• Work with the Program Manager regarding patient status, prescriber feedback, satisfaction, and program effectiveness.

• Uphold confidentiality and privacy standards.

• Meet training deadlines and comply with all SOPs.

• Undertake additional assigned tasks or projects as required.

⛳️ Requirements

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

• Strong oral and written communication skills.

• Familiarity with medical insurance terminology, reimbursement practices, healthcare billing, physician offices, health insurance processing, or related experience.

• Exceptional problem-solving and decision-making capabilities.

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

• Strong organizational abilities.

• Capacity to thrive in a dynamic, fast-paced environment, multitask, and adapt to changes while adhering to Program Standards.

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

• Empathetic listening abilities.

• Dependable with a solid attendance record.

• Proficient in Microsoft Office products.

• Bilingual candidates preferred.

• Preferred typing speed of at least 35 words per minute with 97% accuracy.

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

• Available to work M-F from 8 AM to 5 PM or 10 AM to 7 PM EST only.

🏝️ Benefits

• Comprehensive 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 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 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.

• Nine paid holidays plus two floating holidays.

• Opportunities for career advancement and personal as well as professional development.

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

• An inclusive workplace with a mission-driven culture.

• Preference for minimal travel flexibility.