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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in patient access management, insurance reimbursement processes, and healthcare compliance regulations. Proficient in managing patient inquiries, conducting benefit investigations, and providing personalized case management to ensure medication coverage and access.
Highest-signal resume keywords
Insurance ReimbursementPatient Access ManagementHealthcare Compliance RegulationsMedical TerminologyEffective Communication
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
ICD-10CPTHCPCSBenefit InvestigationsPrior AuthorizationsClaims Status DocumentationReimbursement ActivitiesPatient EducationCase ManagementTrend Analysis
Soft Skills
Attention to DetailOrganizational SkillsCritical ThinkingIssue ResolutionInterpersonal Skills
Tools & Technologies
Lynk Technology
Industry Keywords
HIPAAMedicare GuidelinesMedicaid GuidelinesPatient JourneyHealthcare Provider Education
About the role
Key responsibilities & impact- Own the patient journey from initiation to closure
- Complete benefit investigations and track prior authorizations and denial appeals
- Assist patients and callers/stakeholders through resolution via email, inbound/outbound calls, and Lynk technology
- Advise patients, caregivers, healthcare providers, and clients on insurance coverage, benefits, eligibility, and reimbursement challenges
- Educate healthcare provider offices on payer processes and procedures
- Build trusted relationships with patients, prescribers, specialty pharmacies, healthcare professionals, and client stakeholders
- Manage inbound calls and triage patients to appropriate resources
- Conduct post-benefits-investigation calls explaining coverage options and next steps
- Manage client and healthcare provider inquiries according to business rules
- Provide personalized case management and communicate next steps for obtaining medication coverage and access
- Identify plan benefit coverage, prior authorization, appeals, tier exceptions, and formulary exclusions
- Follow up with payers and healthcare providers on submissions and outcomes
- Coordinate nurse teaching with nurse educators and support adherence services
- Identify peer-support resources and communicate prior-authorization reverification or re-enrollment needs
- Report adverse events, product complaints, special situation reports, and medical inquiries according to procedures
- Document reimbursement activities, claims status, payments, and appeals in Lynk
- Generate reports and analysis to identify trends and improvement opportunities
- Follow corporate policies, SOPs, training deadlines, and assigned projects
Requirements
What you’ll need- Completion of Bachelor's degree (or higher) required; degree in healthcare administration, social science, or similar related fields strongly preferred
- In lieu of a degree, five plus years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education required
- Two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education required
- Minimum two years of experience in healthcare access delivery or management strongly preferred
- Other certifications and five or more consecutive years of experience in a relevant field may be considered
- Strong understanding of medical terminology, ICD-10, CPT, HCPCS, and insurance processes
- Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines
- 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
- Critical thinking and issue-resolution ability
- Bilingual skills are a plus
- Prefer candidates able to type at least 35 words per minute with 97% accuracy
- Successful completion of a background check and, depending on the position, a drug screen
- Remote work eligibility subject to work-from-home criteria and business need
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