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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 coverage identification and managing inquiries while adhering to business rules and SOPs.
Highest-signal resume keywords
Patient Case ManagementBenefit InvestigationsPrior AuthorizationsClear CommunicationCustomer Service
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 AuthorizationsDenial AppealsFinancial QualificationsCase ManagementDocumentationTyping Speed (35 WPM)Electronic Tools UsageSOP ComplianceProgram Coordination
Soft Skills
Detail OrientedProfessional Telephone EtiquetteMultitaskingFlexibilityBuilding Relationships
Tools & Technologies
PharmaCord Lynk SystemLynk Technology
Industry Keywords
Healthcare IndustryPatient Assistance ProgramsPayer CoverageAdverse Events ReportingClient Stakeholders
About the role
Key responsibilities & impact- Own patient cases from initiation to closure
- Perform benefit investigations, prior authorizations, denial appeals, and 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 business rules
- Manage inbound calls and triage patients to appropriate resources
- Provide personalized case management and communicate benefit coverage and next steps
- Identify benefits and payer 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 and nurse follow-up
- Identify peer support resources
- Coordinate product shipments through patient assistance and bridge programs
- Manage prior authorization reverification and patient assistance program reenrollment needs
- Report adverse events, product complaints, special situation reports, and medical inquiries according to SOPs and business rules
- Document all activities in the PharmaCord Lynk system
- Complete training deadlines and follow SOPs
- 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 to 9 pm, Monday to Friday required
- Bi-lingual skills in Spanish and English are a plus
- Remote work eligibility is subject to all work from home criteria being met and based on business need
- Detail oriented
- Professional telephone etiquette
- Basic computer knowledge
- Ability to multitask effectively
- Clear and concise communication
- Prefer candidates who can type at least 35 words per minute with 97% accuracy
- Flexibility to travel as needed preferred
- Successful completion of a background check and, depending on the 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
- Minimal travel flexibility preferred