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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in patient case management, including benefit investigations, prior authorizations, and effective communication with patients and healthcare providers. Proficient in utilizing electronic tools for identifying payer benefits and managing inquiries while adhering to corporate policies and SOPs.
Highest-signal resume keywords
Patient Case ManagementBenefit InvestigationsPrior Authorization ManagementBilingual Communication (Spanish and English)Customer Service Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Benefit InvestigationsPrior AuthorizationsCase ManagementTyping (35 Words Per Minute)Financial Qualifications Assessment
Soft Skills
Detail OrientedClear CommunicationProfessional Telephone EtiquetteMultitasking AbilityRelationship Building
Tools & Technologies
PharmaCord Lynk SystemElectronic Tools for Payer Benefits
Industry Keywords
Healthcare IndustryPatient Assistance ProgramsSOPsAdverse Events ReportingClient Stakeholders
About the role
Key responsibilities & impact- Own patient cases from initiation to closure
- Conduct benefit investigations and prior authorizations/denial appeals
- Determine financial qualifications for assistance programs
- Assist patients, callers, and stakeholders through resolution via email, inbound/outbound calls, and Lynk technology
- Build trusted relationships with patients, prescribers, and client stakeholders
- Perform program welcome calls and post-benefits-investigation calls
- Explain coverage options to patients and physicians
- Manage client and healthcare provider inquiries according to program rules
- Manage inbound calls and triage patients to appropriate resources
- Provide personalized case management and communicate benefit coverage and next steps
- Identify payer benefits and coverage using electronic tools and manual investigations
- Communicate prior authorization, appeal, tier exception, and formulary exclusion requirements
- Follow up with payers and healthcare providers on submissions and outcomes
- Coordinate nurse education, nurse follow-up, peer support, and product shipments
- Manage prior authorization reverification and patient assistance re-enrollment needs
- Report adverse events, product complaints, special situation reports, and medical inquiries according to SOPs
- Document all activities in the PharmaCord Lynk system
- Follow corporate policies, SOPs, and training deadlines
- Perform additional assigned tasks or projects
Requirements
What you’ll need- Bachelor’s degree strongly preferred or equivalent experience required
- Customer service and healthcare industry experience preferred but not required
- Ability to work an 8.5-hour shift between 8 am and 9 pm, Monday to Friday required
- Basic computer knowledge
- Detail oriented
- Professional telephone etiquette
- Ability to multitask effectively
- Clear and concise communication
- Ability to type at least 35 words per minute with 97% accuracy preferred
- Spanish and English bilingual skills are a plus
- Flexibility to travel as needed preferred
- Must meet all work-from-home criteria; remote eligibility based on business need
- Successful completion of a background check and, depending on position, a drug screen
Benefits
Comp & perks- 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
- Background check and, depending on position, drug screen as conditions of employment