Reimbursement Case Manager

Valeris•Remote, North Carolina, NC

About The Position

As a Reimbursement Case Manager at Valeris, you provide inbound and outbound phone support and serve as the primary contact for patients, caregivers, and healthcare providers. You coordinate and monitor patient needs and facilitate their journey through manufacturer Patient Support Program services. The role focuses on delivering excellent customer service, coordinating resources, exchanging information, and ensuring appropriate delivery of services. You handle day-to-day reimbursement activities, including interactions with health insurance companies to verify financial aspects of healthcare services and help patients access prescribed treatments. You serve as an expert on reimbursement, copay assistance, foundation assistance, patient assistance programs, and other forms of support. The position also involves insurance benefit investigations, reviewing enrollment forms, managing cases, documenting information, and supporting prior authorization and appeals processes. The stated schedule is Monday through Friday, 9:00 a.m. to 6:00 p.m. EST. The position operates in a professional office environment and uses standard office equipment. Minimal travel flexibility is preferred.

Requirements

Associate or bachelor’s degree preferred, or a minimum of 4 years of call center or customer service experience with progressive levels of responsibility in a service-driven environment.
Ability to communicate effectively orally and in writing.
Knowledge of medical insurance terminology and reimbursement or insurance, healthcare billing, physician office, health insurance processing, or related experience.
Excellent problem-solving and decision-making skills.
Attention to detail and consistent follow-through in communications with patients, providers, and internal stakeholders.
Strong organizational skills.
Ability to work in a dynamic, fast-paced environment, multitask, and adapt to change while adhering to program standards.
Strong interpersonal skills and ability to work independently and as part of a team, including helping others as needed.
Empathetic listening skills for effective interactions with patients and providers.
Punctuality, reliability, and a strong attendance record.
Proficiency with Microsoft products.

Nice To Haves

Ability to type at least 35 words per minute with 97% accuracy.
Flexibility to travel as needed.

Responsibilities

Provide inbound and outbound phone support as the primary contact for patients, caregivers, and healthcare providers.
Coordinate and monitor patient needs and facilitate patient access to services offered through manufacturer Patient Support Programs.
Handle reimbursement, copay, foundation assistance, patient assistance program, and other support-related issues.
Advocate for patients regarding eligibility requirements, program enrollment, reimbursement processes, affordability support, and access to prescribed therapy.
Establish relationships and maintain trust and rapport with patients, payers, and healthcare providers.
Serve as a direct point of contact for healthcare providers, providing ongoing support and detailed program or patient information.
Help patients and healthcare professionals verify insurance coverage, medical billing, reimbursement processes, and access to complex pharmaceuticals.
Evaluate program enrollment forms for data integrity.
Conduct insurance benefit investigations and triage cases according to program standard operating procedures.
Follow program guidelines and escalate complex cases according to program policies, SOPs, call guides, and other program materials.
Use the case management system to document case status and background, communicate patient benefits, and assist with prior authorization and appeals processes.
Understand and explain benefits offered by private, commercial, and government payers, including Medicare, Medicaid, VA, and DOD.
Act as an assigned liaison to client contacts, Program Management, internal stakeholders, and healthcare providers.
Maintain records in accordance with applicable program standards and regulations.
Provide customer service as a brand advocate and program representative, using resources appropriately and pursuing quality outcomes.
Work day to day with the Program Manager to maintain communication and share information about patient status, prescriber feedback and satisfaction, and program effectiveness.
Understand the health and disease states of patients in the programs.
Maintain ethical conduct regarding confidentiality and privacy.
Support team morale by consistently demonstrating a positive attitude and using Valeris’ values to contribute to team success.
Complete training deadlines for corporate policies and procedures and follow all SOPs consistently.
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 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 maximum of $300,000.
Company-paid 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 and immediate vesting.
Paid Time Off and Sick Leave.
Nine paid holidays plus two floating holidays.
Opportunities for advancement and personal and professional growth.
A challenging, stimulating work environment that encourages new ideas.
An inclusive workplace and mission-driven culture.