Patient Navigator
Posted 2ds ago
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Job Description
Patient Navigator supporting medication access for Valeris, a life sciences commercialization partner. Managing reimbursement, prior authorizations, appeals, and personalized patient support.
Responsibilities:
- Serve as the single point of contact and provide personalized case management for patients, caregivers, and healthcare providers
- Deliver benefit investigations, track prior authorizations, and support appeals
- Educate patients, healthcare providers, and stakeholders on access and reimbursement processes, payer policies, and patient assistance and copay programs
- Build and maintain trusted relationships with patients, prescribers, and client stakeholders
- Coordinate and collaborate with client field teams according to business rules and guidelines
- Communicate benefit coverage options and next steps in the patient journey using clear, patient-friendly language
- Use electronic tools to navigate and complete benefit investigations and secure payer coverage for prescribed treatments
- Ensure activities comply with healthcare laws, regulations, HIPAA, insurance guidelines, and standard operating procedures
- Identify and escalate adverse events, product complaints, and special situation reports
- Document all activities in the Mercalis system with detailed and accurate records
- Support adherence services, including patient education and nurse-teaching coordination as applicable
- Participate in team meetings and ongoing training
- Follow Valeris values, corporate policies, procedures, and SOPs
- Complete additional tasks or projects as assigned
Requirements:
- Completion of Bachelor's degree (or higher) required
- Degree in healthcare administration, social science, or a similar related field strongly preferred
- Minimum two (2) years of experience in healthcare access delivery or management strongly preferred
- Five (5) to ten (10) years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education may be considered in lieu of a degree
- Other certifications and five (5) or more consecutive years of relevant experience may be considered
- Examples of certifications include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist), or CCM (Certified Case Manager) in healthcare or social science
- Strong understanding of medical terminology and ICD-10, CPT, and HCPCS coding systems
- Knowledge of insurance processes
- Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines
- Ability to prioritize tasks and work efficiently in a fast-paced environment
- Bilingual or multilingual ability is a plus
- Ability to type at least 35 words per minute with 97% accuracy preferred
- Flexibility to travel as needed preferred
- Ability to work in a professional office environment using computers, phones, and photocopiers
- 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 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
- Background check and, depending on the position, drug screen required as a condition of employment
