Reimbursement Specialist

Valeris•Jeffersonville, IN

2d•Onsite

About The Position

Valeris is a life sciences commercialization partner formed by the merger of PharmaCord and Mercalis. The Reimbursement Specialist provides information about client programs and supports patients, healthcare providers, and insurance companies with inquiries, service requests, benefit coverage assessments, and barriers to therapy access. This is a customer service role providing telephonic and, where applicable, web-based support in a compliant and compassionate manner. The role includes verifying patient benefits, coordinating prior authorizations, reviewing patient assistance applications and eligibility, communicating eligibility decisions, and assisting callers. Specialists use PharmaCord Lynk for claims processing and workflow management, communicate case status to medical practice accounts and sales representatives, and provide consultative support to help resolve barriers to paid therapy. The position is office-based and operates in a professional office environment. The employee must be able to sit for extended periods and routinely use standard office equipment.

Requirements

High school diploma or GED required.
Bachelor’s degree strongly preferred, or equivalent experience required.
At least 6 months of customer service experience, payer benefits experience, healthcare industry experience, or healthcare-related certification, license, or equivalent coursework is strongly preferred.
Service-minded approach focused on recognizing and meeting the needs of others, especially patients and care partners.
Ability to handle personal health information confidentially.
Honesty, integrity, professionalism, and sound customer service etiquette.
Clear verbal and written communication skills.
Accountability for results, ability to plan and prioritize tasks, and strong attention to detail.
Emotional intelligence, including recognizing emotions and their effects.
Ability to manage disruptive impulses and handle potentially stressful customer interactions.
Proficient computer skills and 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.
Regularly required to talk or hear; frequently required to sit for long periods, use hands to type, handle, or feel, and reach with hands and arms.

Nice To Haves

Bilingual ability.
Ability to type at least 35 words per minute with 97% accuracy.
Flexibility to travel as needed, 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 according to payer guidelines and applicable laws, regulations, or guidance.
Review patient assistance enrollment forms and supporting documents to assess eligibility under SOPs and program guidelines.
Determine patient eligibility based on program criteria and communicate eligibility to patients, healthcare providers, and/or consignment pharmacies.
Answer and assist inbound callers through resolution, using FAQs or warm transfers to appropriate individuals.
Listen to customers, assess their needs, and respond with patience and courtesy.
Identify missing or incorrect information in program service requests and applications.
Report adverse events and product complaint inquiries in accordance with SOPs and good manufacturer practices.
Provide timely feedback to the company about service failures or customer concerns.
Use the PharmaCord Lynk internal technology platform to process claims and keep workflows moving.
Communicate case status with medical practice accounts and sales representatives, and provide consultative support on overcoming obstacles to paid therapy.
Maintain a patient-focused approach while following company policies, procedures, and compliance requirements.
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 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 (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 culture and deliberate efforts to create an inclusive workplace.