Reimbursement Case Manager

Key Responsibilities

• Reimbursement Case Managers may be regionally aligned and will serve as an expert on reimbursement, co-pay, foundation assistance, PAP issues, and other forms of available support and will be responsible for handling patient and healthcare provider interactions
• Serve as an advocate to patients regarding eligibility requirements, program enrollment, reimbursement process, affordability support, and general access for prescribed therapy
• Establish relationships, develop trust, and maintain rapport with patients, payers and healthcare providers
• Serve as direct point of contact to health care providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient
• Serve as a resource for patients and healthcare professionals to verify insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals
• Evaluate program enrollment forms for data integrity
• Responsible for 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.
• Working case management system, documenting status/background in case notes, communicating patient benefits, assisting in the PA/Appeals process and like responsibilities
• Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD)
• Act as an assigned liaison to client contacts (e.g., regional contact for sales representatives), Program Management, other internal stakeholders and Healthcare Providers
• Maintain records in accordance with applicable standards and regulations to the programs/promotions
• Provide unparalleled customer service while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources
• Works with the Program Manager, on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction and program effectiveness
• Understand health and disease states of patients of the programs
• Maintains a high level of ethical conduct regarding confidentiality and privacy
• Help maintain team morale by consistently demonstrating positive attitude
• Utilize Valeris’ values as the driving force behind the team’s success
• On time adherence to training deadlines for all corporate policies and procedures
• Ensure all SOPs are followed with consistency
• Perform additional tasks or projects as assigned

Qualifications

• Associate or Bachelor’s degree preferred; or a minimum of 4 years of call center or customer service experience with progressive levels of responsibility within a service driven environment
• Ability to communicate effectively both orally and in writing
• Knowledge of medical insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related experience
• Excellent problem-solving and decision-making skills required
• Attention to detail and committed follow through in communication with patients, providers and internal stakeholders
• Strong organizational skills
• Willing to work in a dynamic, fast paced environment and have the ability to multi-task and adapt to change while adhering to Program Standards
• Strong interpersonal skills, ability to work both independently and as part of a team, ability to jump in and help others as needed
• Empathetic listening skills in order to interact effectively with patients and providers
• Punctual, reliable with strong attendance record
• Proficient with Microsoft products

Physical Demands & Work Environment

Why Work for Valeris?

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