Senior Patient Navigator

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

📋 Description

• Act as the primary contact for patients, caregivers, and healthcare professionals.

• Deliver tailored case management, conduct benefit investigations, track prior authorizations, and provide appeal assistance.

• Inform patients, healthcare providers, and relevant stakeholders about access, reimbursement, payer guidelines, and Valeris programs.

• Establish and nurture relationships with patients, prescribers, and client stakeholders.

• Collaborate with client field teams in accordance with established business rules and guidelines.

• Convey benefit coverage options and subsequent steps using patient-friendly language.

• Utilize electronic tools to carry out benefit investigations and secure payer coverage.

• Ensure adherence to healthcare laws, regulations, HIPAA, insurance protocols, and Valeris standard operating procedures (SOPs).

• Recognize and escalate adverse events, product complaints, and special situation reports.

• Accurately record activities in the Valeris system.

• Assist with adherence services, patient education, and coordination of nurse teaching.

• Take part in team meetings and ongoing training sessions.

• Travel to the designated nearby headquarters in Morrisville, NC or Jeffersonville, IN as needed a few times per quarter.

• Meet training deadlines, adhere to SOPs, and execute assigned tasks or projects.

⛳️ Requirements

• A Bachelor’s degree is required, ideally in healthcare administration, social science, or a related area.

• Alternatively, 5–10 years of relevant experience in insurance reimbursement, patient access, direct patient care, or patient education may be accepted in place of a degree.

• Alternatively, relevant certifications such as PACS, CHES, or CCM combined with at least 5 consecutive years of related experience are acceptable.

• A minimum of two years of experience in healthcare access delivery or management is strongly preferred.

• A robust understanding of medical terminology is essential.

• Familiarity with ICD-10, CPT, and HCPCS coding systems is required.

• Knowledge of insurance processes is necessary.

• Understanding of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines, is important.

• Ability to prioritize tasks and operate effectively in a fast-paced environment is required.

• Bilingual or multilingual skills are advantageous.

• Candidates who can type at least 35 words per minute with 97% accuracy are preferred.

• Willingness to travel as needed is preferred.

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

🏝️ 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 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-sponsored 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, featuring immediate vesting.

• Paid Time Off (PTO) and Sick Leave.

• Nine paid holidays along with two floating holidays.

• Opportunities for career advancement and personal and professional development.

• Engaging and stimulating work environment.

• An inclusive workplace with a mission-driven culture.

• Occasional travel may be required a few times per quarter based on client requests.