Sr. Reimbursement Case Manager/Specialist

Valeris • Jeffersonville, IN

18d • Onsite

About The Position

The Sr. Reimbursement Case Manager provides inbound and outbound phone support and serves as a primary contact for patients, caregivers, and healthcare providers. The role coordinates and monitors patient needs and facilitates access to services offered through manufacturer-sponsored Patient Support Programs. It includes day-to-day reimbursement support, interactions with health insurance companies to verify coverage and financial aspects of care, and assistance helping patients access prescribed treatments.

The position serves as an expert resource on reimbursement, copay assistance, foundation assistance, Patient Assistance Programs (PAP), and other support options. It works with patients, providers, payers, client contacts, program management, and internal stakeholders while following program policies, standard operating procedures, and applicable privacy and recordkeeping requirements. The role may be regionally aligned and may support team operations through case guidance, new-hire nesting, and reporting.

This job operates in a professional office environment and routinely uses standard office equipment, including computers, phones, and photocopiers. The employee is regularly required to talk or hear, frequently sits for long periods, types and handles objects, and reaches with hands and arms. Flexibility to travel as needed is preferred, though travel is described as very minimal.

Requirements

• At least 3 years of case management experience.
• Strong critical-thinking, problem-solving, and decision-making skills.
• Ability to communicate effectively orally and in writing.
• Knowledge of medical insurance terminology and reimbursement, insurance, healthcare billing, physician-office, or health-insurance processing.
• Attention to detail and committed follow-through in communication with patients, providers, and internal stakeholders.
• Strong organizational skills and ability to multitask in a dynamic, fast-paced environment.
• Strong interpersonal skills and ability to work independently and as part of a team.
• Empathetic listening skills for effective interactions with patients and providers.
• Strong customer-service skills and experience.
• Proficiency with Microsoft products.
• Punctuality, reliability, and a strong attendance record.
• Ability to type at least 35 words per minute with 97% accuracy is preferred.
• Flexibility to travel as needed is preferred; travel is described as very minimal.

Nice To Haves

• Associate or bachelor’s degree.
• Medical, pharmacy, and Buy & Bill experience, including familiarity with related insurance, reimbursement, and healthcare workflows.
• Ability to type at least 35 words per minute with 97% accuracy.
• Flexibility to travel as needed.

Responsibilities

• Provide inbound and outbound phone support to patients, caregivers, and healthcare providers as a dedicated contact.
• Coordinate and monitor patient needs and facilitate the patient’s journey through services offered by the Patient Support Program.
• Serve as an expert on reimbursement, copay assistance, foundation assistance, PAP issues, and other available support.
• Advocate for patients regarding eligibility, program enrollment, reimbursement, affordability support, and access to prescribed therapy.
• Establish and maintain trusted relationships with patients, payers, and healthcare providers.
• Provide ongoing support to healthcare providers and communicate detailed information about programs and patients.
• 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 policies, SOPs, call guides, and other program materials.
• Use the case management system to document status and background in case notes, 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.
• Deliver customer service as a brand advocate and program representative, with attention to quality outcomes and appropriate resource use.
• Communicate with supervisors and program managers about patient status, prescriber feedback and satisfaction, and program effectiveness.
• Understand program patients’ health and disease states and maintain ethical conduct regarding confidentiality and privacy.
• Help maintain team morale by demonstrating a positive attitude and assist with conflict resolution.
• Identify and report pharmacovigilance information, including adverse events, as required by clients.
• Serve as a first point of contact for case management issues or questions.
• Assist with new-hire nesting and with reports and reporting analysis for leadership.
• Help the team adapt to change while maintaining program standards and support other team members when needed.
• Meet 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 (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) Retirement Savings 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree