Reimbursement Specialist

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of Pharma Cord and Mercalis, Valeris revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications.

Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients.

The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit  typical day in this role will include providing in-depth knowledge of our client programs by working directly with patients, healthcare providers, and insurance companies to answer inquiries, process service requests, assess benefits coverage, and manage through barriers, in a compliant manner, that stand in the way of patients and their access to therapy.

The Benefits Specialist works in a dynamic and compassionate customer service role providing telephonic and web-based, where applicable, customer service support.

Key Responsibilities:

The responsibilities include, but are not limited to the following:

Benefit Verification:

Performing patient level benefits verifications as applicable for all major medical and pharmacy benefits plans.

Completion of the template forms that provide patient level benefits Coverage Determination Summary.

Coordination of prior authorizations based on payer guidelines and in compliance with law, regulation or guidance.

Patient Assistance:

Review of patient assistance enrollment forms and any supporting documentation to assess patient eligibility for participation as per SOPs and program guidelines.

Determination of patient’s eligibility based upon program criteria for qualification.

Communicating the patient’s eligibility to the patient, healthcare provider, and/or consignment pharmacy.

Answer and assist inbound callers through resolution utilizing answers to frequently asked questions or by warm transferring callers to other appropriate individuals.

Actively listen to each customer, assess needs, and respond with demonstrated patience and courtesy.

Review and identification of information that is missing and/or incorrect within program service requests/program applications.

Reporting of Adverse Events/ Product Complaint inquiries received in accordance with SOP and good manufacturer practices.

Provides timely feedback to the company regarding service failures or customer concerns

Effectively uses our internal technology platform, Pharma Cord Lynk, to complete claims processing and keep workflows moving.

Communicate with key medical practice accounts, sales representatives regarding the status of cases. Provide consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy.

Benefits Specialists are expected to be patient focused and committed to providing the highest quality customer service all while maintaining a sense of compliance and commitment to abiding by company policies and procedures.

Utilize Valeris’ values as the driving force behind the team’s success

On time adherence to training deadlines for all corporate policies and…