Reimbursement Case Manager

Valeris•Remote, North Carolina, NC

4d•Onsite

About The Position

As a Reimbursement Case Manager, you provide inbound and outbound phone support and serve as the primary contact for patients, caregivers, and providers. You coordinate and monitor patient needs and facilitate each patient’s journey using services offered through a manufacturer’s Patient Support Program. The role focuses on delivering customer service by coordinating resources, exchanging information, and ensuring appropriate delivery of services, including day-to-day reimbursement activities and interactions with health insurance companies to verify financial aspects of healthcare services and support access to treatment. The role may be regionally aligned. Reimbursement Case Managers serve as experts on reimbursement, co-pay assistance, foundation assistance, patient assistance programs, and other available support. They handle patient and healthcare-provider interactions, maintain case records, follow program procedures and applicable standards, and collaborate with Program Management, client contacts, internal stakeholders, and healthcare providers.

Requirements

Associate or bachelor’s degree preferred; alternatively, at least 4 years of call center or customer service experience with progressive responsibility in a service-driven environment.
Effective oral and written communication skills.
Knowledge of medical insurance terminology and reimbursement or insurance, healthcare billing, physician office, health insurance processing, or related experience.
Strong problem-solving and decision-making skills.
Attention to detail and dependable follow-through in communication with patients, providers, and internal stakeholders.
Strong organizational skills.
Ability to work in a dynamic, fast-paced environment, multitask, adapt to change, and adhere 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 interacting effectively 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; travel is expected to be minimal.

Responsibilities

Provide inbound and outbound phone support as the primary contact for patients, caregivers, and providers.
Coordinate and monitor patient needs and facilitate access to Patient Support Program services.
Advocate for patients regarding eligibility, program enrollment, reimbursement, affordability support, and access to prescribed therapy.
Build and maintain relationships and rapport with patients, payers, and healthcare providers.
Serve as a direct contact for healthcare providers, sharing detailed information about programs and patients.
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 policy, 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.
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, supporting quality outcomes and appropriate resource use.
Work 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 served by the programs.
Maintain ethical conduct regarding confidentiality and privacy.
Support team morale by demonstrating a positive attitude and apply Valeris’ values in work.
Meet training deadlines for corporate policies and procedures and follow 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 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 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.
Inclusive workplace and mission-driven culture.