Patient Navigator

Mercalis•Morrisville, NC

3d•Onsite

About The Position

The Patient Navigator plays a critical role in ensuring patients have access to life-altering medications by supporting them through complex processes such as insurance verification, prior authorizations, and appeals. This position combines exceptional customer service, relationship management, and expertise in reimbursement practices to provide personalized support and ensure compliance with all healthcare regulations. The role also focuses on educating healthcare providers and patients on access, coverage, and reimbursement support. These roles will be regionally aligned to best support patients.

Requirements

Completion of Bachelor's degree (or higher) required.
A degree in healthcare administration, social science or similar related fields is strongly preferred.
Minimum two (2) years of experience in healthcare access delivery or management is strongly preferred.
five (5) to ten (10) years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education experience will be considered in lieu of degree.
Other certifications and five (5) or more consecutive years of experience in relevant field could be considered. Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager).
Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
Ability to prioritize tasks and work efficiently in a fast-paced environment.
Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
Bilingual / Multilingual is a plus.

Nice To Haves

Prefer candidates who can type at least 35 words per minute with 97% accuracy.
Although very minimal, flexibility to travel as needed is preferred.

Responsibilities

Serves as the single point of contact and provides personalized case management for patients, caregivers, and healthcare providers (HCPs), including delivery of benefit investigations, prior authorization tracking, and appeal support.
Educate patients, HCPs, and stakeholders on access and reimbursement processes, payer policies, and Mercalis programs (e.g., patient assistance programs, copay programs).
Build and maintain trusted relationships with patients, prescribers, and client stakeholders by delivering accurate, timely, and compassionate support.
Coordinate and collaborate with client field teams, following agreed upon business rules and guidelines
Communicate benefit coverage options and next steps in the patient journey using clear and patient-friendly language.
Leverage electronic tools to navigate and complete benefit investigations, ensuring payer coverage is secured for prescribed treatments.
Ensure all activities comply with healthcare laws, regulations, and Mercalis standard operating procedures (e.g., HIPAA, insurance guidelines).
Identify and escalate adverse events, product complaints, and special situation reports as required by the program.
Document all activities in the Mercalis system, maintaining detailed and accurate records.
Support adherence services, including patient education and coordinating nurse teaching as applicable.
Participate in team meetings and ongoing training to stay updated on policies and procedures.
Utilize Valeris’ values as the driving force behind the team’s success
On time adherence to training deadlines for all corporate policies and procedures
Ensure all SOPs are followed with consistency
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
Additional health support, including telehealth and Employee Assistance Program (EAP) services
Company match on Health Savings Account contributions
Free Basic Life and AD&D coverage equal to your 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) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
Paid Time Off (PTO) and Sick Leave to support work-life balance
Team members receive nine paid holidays plus two floating holidays
Opportunities for advancement in a company that supports personal and professional growth
A challenging, stimulating work environment that encourages new ideas
Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
A mission-driven, inclusive culture where your work makes a meaningful impact