Executive Care Coordinator
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Job Description
Executive Care Coordinator guiding patients through insurance reimbursement and access to complex medications. Supporting Valeris’ life sciences commercialization and patient-support services.
Responsibilities:
- Manage the patient journey from initiation to closure
- Complete benefit investigations and track prior authorizations and denial appeals
- Assist patients, caregivers, healthcare providers, specialty pharmacies, and other stakeholders through resolution via email, inbound/outbound calls, and Lynk technology
- Explain coverage options and next steps after benefits investigations
- Manage client and healthcare-provider inquiries
- Build trusted relationships through proactive, timely, and accurate communication
- Triage patients to internal or external resources as appropriate
- Provide personalized case management and communicate benefit coverage and next steps
- Identify prior authorization, appeal, tier exception, and formulary exclusion requirements
- Contact payers and healthcare providers to follow up on submissions and outcomes
- Coordinate nurse teaching with nurse educators and support adherence services
- Identify peer-support resources and communicate reverification or re-enrollment needs
- Identify and report adverse events, product complaints, special situation reports, and medical inquiries
- Document reimbursement activities, claims status, payments, and appeals in Lynk
- Generate reports and analysis to identify trends and improvement opportunities
- Serve as a subject matter expert to the internal team
- Follow SOPs, corporate policies, training deadlines, and program operating procedures
- Perform additional tasks or projects as assigned
Requirements:
- Completion of Bachelor's degree (or higher) required; degree in healthcare administration, social science or similar related fields strongly preferred
- In lieu of a degree, five plus years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is 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 experience in a relevant field may be considered; examples include PACS, CHES, or CCM
- Strong understanding of medical terminology and coding systems (ICD-10, CPT, HCPCS)
- Knowledge of insurance processes, HIPAA, and Medicare/Medicaid guidelines
- Ability to meet work-from-home criteria, subject to business need
- Ability to type at least 35 words per minute with 97% accuracy preferred
- 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
- Critical-thinking and issue-resolution abilities
- Bilingual skills are a plus
- Successful completion of a background check and, depending on 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 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% 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
- Challenging, stimulating work environment that encourages new ideas
- Inclusive workplace and mission-driven culture
- Flexibility to travel as needed is preferred
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