Care Coordinator

• Care Coordinator may be regionally aligned and will serve as an expert on all aspects of benefit coordination, and other forms of available support and will be responsible for handling healthcare provider and/or patient interactions
• May serve as an advocate to patients regarding eligibility requirements, program enrollment, affordability support, and general access for prescribed therapy
• Establishes relationships, develop trust, and maintain rapport with healthcare providers and/or patients
• Serves as 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
• Strong working knowledge and ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD); with expertise in Medicare Part B
• Navigates through payer challenges by asking appropriate questions to obtain the necessary result
• Acts as an assigned liaison to client contacts (e.g., regional contact for sales representatives)
• Maintains records in accordance with applicable standards and regulations to the programs/promotion
• Follows program guidelines and escalates complex cases according to SOPs, Call Guides, and other program materials.
• Liaison between Program Management, other internal stakeholders, and healthcare providers
• Provides unparalleled customer service, with attention to detail, while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commits to the appropriate use of resources
• Works with all levels of Program Management on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction, coordination challenges and program effectiveness
• Understands the nature of the disease states of patients of the program
• Assesses situations to act and intervene where needed to obtain a timely result
• Maintains a high level of ethical and professional conduct regarding confidentiality and privacy
• Helps maintain team morale by consistently demonstrating a positive attitude and strong work ethics
• Utilizes the necessary resources for conflict resolution as needed.

• Associate or bachelor’s degree and 2 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing preferred, or in lieu of a degree, a High School diploma or equivalent with 5 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing
• Call Center/HUB or customer service experience with progressive levels of responsibility within a service driven environment required
• Excellent communication skills; orally and in writing
• Strong working knowledge of prior authorization and appeals is required
• Strong knowledge of medical and pharmacy insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related benefit coordination experience
• Excellent problem-solving and decision-making skills required
• Attention to detail and committed follow through in communication with patients, providers, and internal/external stakeholders
• Strong organizational skills for fast paced environment
• Ability to adapt to change while maintaining Program standards
• Strong team players are willing to jump in and help other team members when needed.
• Empathetic listening skills to interact effectively with patients and providers.
• Punctual, reliable with strong attendance record
• Strong customer service experience and skills
• Proficient with Microsoft products (Excel, Word, PowerPoint, and Outlook)

Physical Demands & Work Environment

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.
• Although very minimal, flexibility to travel as needed is preferred.
• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

Why Work for Valeris?

We’re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
• Additional health support, including 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 to support work-life balance
• Team members receive nine paid holidays plus two floating holidays
• Opportunities for advancement in a company that supports personal and professional growth
• A challenging, stimulating work environment that encourages new ideas
• Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
• A mission-driven, inclusive culture where your work makes a meaningful impact

Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice.

Our Commitment to Equal Opportunity