Reimbursement Specialist
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Job Description
Reimbursement Specialist supporting patient access to life-saving medications at Valeris. Verifying insurance benefits and coordinating reimbursement assistance for patients, providers, and caregivers.
Responsibilities:
- Provide inbound and outbound phone support as the primary contact for patients, caregivers, and providers
- Coordinate and monitor patient needs throughout the Patient Support Program journey
- Handle day-to-day reimbursement services activities
- Interact with healthcare insurance companies to verify financial aspects of healthcare services
- Advise patients on eligibility requirements, program enrollment, reimbursement processes, affordability support, and therapy access
- Establish relationships and maintain rapport with patients, payers, and healthcare providers
- Provide ongoing support and program information to healthcare providers
- Verify insurance coverage, medical billing, reimbursement processes, and access for complex pharmaceuticals
- Evaluate program enrollment forms for data integrity
- Conduct insurance benefit investigations and triage cases according to standard operating procedures
- Follow program guidelines and escalate complex cases according to policies, SOPs, Call Guides, and program materials
- Maintain case records and document status and background in the case management system
- 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
- Liaise with client contacts, Program Management, internal stakeholders, and healthcare providers
- Maintain records according to applicable standards and regulations
- Serve as a brand advocate and program representative while delivering customer service and quality outcomes
- Collaborate with the Program Manager regarding patient status, prescriber feedback, satisfaction, and program effectiveness
- Maintain confidentiality and privacy
- Meet training deadlines and follow all SOPs
- Perform additional assigned tasks or projects
Requirements:
- 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
- Attention to detail and committed follow-through
- Strong organizational skills
- Ability to work in a dynamic, fast-paced environment, multitask, and adapt to change while adhering to Program Standards
- Strong interpersonal skills and ability to work independently and as part of a team
- Empathetic listening skills
- Punctuality, reliability, and strong attendance record
- Proficient with Microsoft products
- Bilingual preferred
- Ability to type at least 35 words per minute with 97% accuracy preferred
- Successful completion of a background check and, depending on the position, a drug screen
- M-F 8A-5P or 10A-7P EST only
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 encouraging new ideas
- Inclusive workplace and mission-driven culture
- Minimal travel flexibility preferred
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