Executive Care Coordinator, Bilingual

Valeris•Durham, NC

15d

About The Position

Valeris is hiring a bilingual Executive Care Coordinator to help patients navigate access to complex medications. The role provides patient-centered support throughout the patient journey, from initiation to closure, by managing records accurately, explaining program requirements in patient-friendly language, and helping resolve access and reimbursement challenges. The coordinator communicates with patients, caregivers, prescribers, specialty pharmacies, healthcare professionals, clients, and other stakeholders through inbound and outbound calls, email, and Valeris’ Lynk technology. The required shift is 11:30 AM–8:00 PM ET. Remote work eligibility depends on meeting work-from-home criteria and business need. The coordinator provides information about insurance coverage, reimbursement, program eligibility, and available access and affordability support. Work includes benefit investigations, prior authorizations and denial appeals, follow-up with payers and healthcare providers, case documentation, and support for adherence and other program services. The role follows program rules, applicable laws, regulations, HIPAA requirements, insurance guidelines, and industry standards. It operates in a professional office environment and routinely uses computers, phones, and photocopiers.

Requirements

Fluency in both Spanish and English.
Bachelor’s degree or higher; in lieu of a degree, five or more years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education.
Two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education.
Strong understanding of medical terminology, coding systems including ICD-10, CPT, and HCPCS, and insurance processes.
Demonstrated ability to work within established guardrails, recognize urgency, and consistently deliver patient-centered results.
Strong attention to detail and organizational skills.
Ability to prioritize tasks and work efficiently in a fast-paced environment.
Effective written and verbal communication and interpersonal skills, including the ability to interact professionally with diverse stakeholders.
Critical-thinking and issue-resolution abilities.
Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
Meet applicable work-from-home criteria if seeking remote-work eligibility; remote eligibility is also subject to business need.

Nice To Haves

Degree in healthcare administration, social science, or a similar related field.
At least two years of experience in healthcare access delivery or management.
Relevant certification, such as PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist), or CCM (Certified Case Manager) in healthcare or social science.
Ability to type at least 35 words per minute with 97% accuracy.
Flexibility to travel as needed.

Responsibilities

Build trusted relationships with patients, prescribers, and appropriate client stakeholders through proactive communication and timely, accurate work.
Handle inbound and outbound calls with patients, caregivers, specialty pharmacies, and healthcare professionals within a call/contact center structure.
Conduct post-benefit-investigation calls to explain coverage options and next steps to patients and/or physicians.
Respond to client and healthcare-provider inquiries, including case-status questions, in accordance with program rules and business protocols.
Manage patient and healthcare-provider cases, including communicating benefit coverage and next steps for obtaining coverage or access to prescribed medication.
Triage patients to internal or external resources as appropriate.
Use electronic tools to identify benefits and payer coverage and complete manual benefit investigations when needed.
Identify and communicate plan coverage details, including prior authorization, appeals, tier exceptions, and formulary exclusions.
Use electronic resources and, when needed, contact payers and healthcare providers to follow up on benefit outcomes and submission status.
Coordinate nurse education appointments and support adherence services when applicable to the program.
Identify peer-support resources for patients and proactively communicate needs for prior-authorization reverification or program re-enrollment.
Identify and report adverse events, product complaints, special situation reports, and medical inquiries in accordance with program procedures and business rules.
Document activities in Lynk, maintaining detailed records of reimbursement activity, claims status, payments, and appeals.
Generate reports and analyses as needed to identify trends and opportunities for improvement.
Serve as an internal subject-matter expert when required and appropriate.
Follow applicable laws, regulations, program procedures, industry standards, client-team protocols, corporate policies, and SOPs.
Meet training deadlines and perform additional tasks or projects as assigned.

Benefits

Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs.
Telehealth and Employee Assistance Program (EAP) services.
Company match on Health Savings Account contributions.
Free 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 the option to purchase Long-Term Disability.
401(k) plan with 100% match on the first 5% contributed and immediate vesting.
Paid Time Off and Sick Leave.
Nine paid holidays plus two floating holidays.
Advancement opportunities and support for personal and professional growth.
A challenging, stimulating work environment that encourages new ideas.
Inclusive culture and deliberate efforts to create an inclusive workplace.