[Hiring] Executive Case Manager @Valeris

Role Description

When you join the team as an Executive Case Manager, you'll have the opportunity to make a difference in the lives of our patients each day as they look to you as part of their dedicated support team for helping them navigate the tricky process of getting access to their complex medication. You'll compassionately deliver an exceptional experience to many patients per day, always remembering that every prescription or document belongs to a real person who is looking for thorough and efficient management of their records. You'll adjust your approach to their needs by communicating clearly, focusing on the accuracy of the details of their medical records, your mastery of the program requirements, and ensuring their prescriptions or cases are handled in a timely manner. An Executive Case Manager has the ability to translate knowledge into patient friendly language and education.

A typical day in this role will include ownership of your patient journey from initiation to closure by using your critical thinking skills and your knowledge of the program and industry rules and standards. This includes:

• Completing benefit investigations
• Tracking prior authorizations / denial appeals
• Assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our patented technology, Lynk)

This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to navigate complex reimbursement processes.

The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. Responsibilities include:

• Education on the access and reimbursement support tools available from Valeris and participating program
• Advising HCPs and/or patients and caregivers on the benefits and program eligibility for a specific patient
• Educating HCP offices on Payor processes and procedures

Qualifications

• Completion of Bachelor's degree (or higher) required. Degree in healthcare administration, social science or similar related fields is 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 is required.
• Minimum two years of experience in healthcare access delivery or management is strongly preferred.
• Will consider other certifications and five or more consecutive years of experience in relevant field.
• Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
• Demonstrated examples of executing within guardrails recognizing urgency and consistently delivering patient centric results.
• 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, with the ability to interact professionally with diverse stakeholders.
• Demonstrates the ability to think critically and issue resolution.
• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
• Bi-lingual skills are a plus.
• Remote work eligibility is subject to all work from home criteria met and based on business need.

Requirements

• 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.

Benefits

• 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.