Reimbursement Specialist

Valeris • Remote, Kentucky, KY

9d • Onsite

About The Position

The Reimbursement Specialist provides program support by working directly with patients, healthcare providers, and insurance companies to answer inquiries, process service requests, assess benefits coverage, and address barriers to patients’ access to therapy in a compliant manner. This patient-focused customer service role provides telephonic and, where applicable, web-based support in a dynamic and compassionate environment.

The role performs patient-level benefits verifications, prepares coverage determination summaries, coordinates prior authorizations, and reviews patient assistance applications to determine eligibility under program criteria. It also responds to callers, identifies missing or incorrect information, reports adverse event and product complaint inquiries, and uses the PharmaCord Lynk platform to process claims and maintain workflows. The specialist communicates case status and consultative guidance to medical practice accounts and sales representatives while following company policies, procedures, and SOPs.

This is an office-based position in a professional office environment. It routinely uses standard office equipment. The ability to sit for extended periods is necessary; very minimal travel may be needed. Full-time employees are offered health and welfare coverage, retirement benefits, paid leave, and other support for well-being and professional growth.

Requirements

• High school diploma or GED required.
• Bachelor’s degree strongly preferred, or equivalent experience required.
• Service-minded approach focused on recognizing and meeting the needs of patients and care partners.
• Ability to handle personal health information confidentially.
• Commitment to honesty and integrity.
• Professionalism and strong business and customer service etiquette.
• Clear verbal and written communication skills.
• Accountability for results.
• Ability to plan and prioritize tasks, with strong attention to detail.
• Emotional intelligence, including the ability to recognize emotions and their effects.
• Ability to manage disruptive impulses and handle potentially stressful customer interactions.
• Proficient computer skills.
• Adaptability to change.
• Personal initiative and commitment to team and organizational goals.
• Ability to work effectively within a team.
• Ability to sit for extended periods of time.
• Ability to talk or hear regularly, sit for long periods frequently, use hands to type, handle, or feel, and reach with hands and arms.
• Ability to type at least 35 words per minute with 97% accuracy is preferred.

Nice To Haves

• Six months of customer service experience, payer benefits experience (such as reimbursement or prior authorization), healthcare industry experience, or healthcare-related certification, license, or equivalent coursework is strongly preferred.
• Bilingual ability is a plus.
• Flexibility to travel as needed is preferred, although travel is very minimal.

Responsibilities

• Perform patient-level benefits verifications for major medical and pharmacy benefit plans, as applicable.
• Complete template forms that provide patient-level benefits Coverage Determination Summaries.
• Coordinate prior authorizations based on payer guidelines and applicable law, regulation, or guidance.
• Review patient assistance enrollment forms and supporting documentation to assess eligibility under SOPs and program guidelines.
• Determine patient eligibility based on program qualification criteria.
• Communicate patient eligibility to patients, healthcare providers, and/or consignment pharmacies.
• Answer inbound calls and assist callers through resolution, including responding to frequently asked questions or warm-transferring callers as appropriate.
• Listen to customers, assess their needs, and respond with patience and courtesy.
• Review program service requests and applications to identify missing or incorrect information.
• Report adverse event and product complaint inquiries in accordance with SOPs and good manufacturer practices.
• Provide timely feedback to the company regarding service failures or customer concerns.
• Use the PharmaCord Lynk internal technology platform to complete claims processing and keep workflows moving.
• Communicate case status to medical practice accounts and sales representatives, and provide consultative guidance on overcoming obstacles to paid therapy.
• Maintain a patient-focused approach and provide high-quality customer service while complying with company policies and procedures.
• Use Valeris’ values to support team success.
• Meet training deadlines for corporate policies and procedures.
• 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 (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) Retirement Savings Plan with a 100% match on the first 5% contributed, with immediate vesting.
• Paid Time Off (PTO) 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED