Executive Care Coordinator, Bilingual
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Job Description
Bilingual Executive Care Coordinator helping Valeris, a life sciences commercialization partner, guide patients through complex medication access and reimbursement.
Responsibilities:
- Deliver an exceptional patient experience while helping patients navigate access to complex medications
- Manage each patient journey from initiation to closure
- Complete benefit investigations and track prior authorizations and denial appeals
- Assist patients, callers, healthcare providers, caregivers, specialty pharmacies, and stakeholders through resolution via email, inbound/outbound calls, and Lynk technology
- Explain coverage options, next steps, benefits, and program eligibility
- Educate healthcare provider offices on payer processes and procedures
- Build and manage trusted relationships with patients, prescribers, and client stakeholders
- Triage patients to internal or external resources as appropriate
- Provide personalized case management and communicate benefit coverage and access next steps
- Identify prior authorization, appeal, tier exception, and formulary exclusion requirements
- Follow up with payers and healthcare providers on submissions and outcomes
- Coordinate nurse teaching with nurse educators and support adherence services as applicable
- Identify peer support resources and proactively communicate reverification or re-enrollment needs
- Identify and report adverse events, product complaints, special situation reports, and medical inquiries
- Document reimbursement activities in Lynk, including claims status, payments, and appeals
- Generate reports and analyses to identify trends and improvement opportunities
- Follow corporate policies, SOPs, program rules, and training deadlines
- Perform additional assigned tasks or projects
Requirements:
- Fluent in both Spanish and English
- Bachelor's degree or higher required
- Degree in healthcare administration, social science, or a related field strongly preferred
- In lieu of a degree, five plus years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education required
- Two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education required
- Minimum two years of experience in healthcare access delivery or management strongly preferred
- Other certifications and five or more consecutive years of relevant experience will be considered
- Knowledge of medical terminology and coding systems, including ICD-10, CPT, and HCPCS
- Strong understanding of insurance processes
- Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines
- Excellent attention to detail and organizational skills
- Ability to prioritize tasks and work efficiently in a fast-paced environment
- Effective written and verbal communication and interpersonal skills
- Ability to think critically and resolve issues
- Ability to type at least 35 words per minute with 97% accuracy preferred
- Remote work eligibility subject to work-from-home criteria and business need
- Successful completion of a background check and, depending on the position, a drug screen
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 your 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 100% match on the first 5% you contribute, 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
- Challenging, stimulating work environment that encourages new ideas
- Inclusive workplace and mission-driven culture
- Minimal travel as needed preferred
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