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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, including benefit investigations, prior authorizations, and reimbursement processes. Proficient in medical terminology, coding systems, and effective communication with diverse stakeholders.
Highest-signal resume keywords
Patient Access ManagementInsurance ReimbursementMedical TerminologyCritical ThinkingEffective 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
Benefit InvestigationsPrior AuthorizationsICD-10CPTHCPCSClaims Status DocumentationReimbursement ActivitiesPatient EducationData AnalysisTyping Speed
Soft Skills
Attention to DetailOrganizational SkillsInterpersonal SkillsIssue ResolutionTime Management
Tools & Technologies
Lynk SystemElectronic ToolsAdherence Services Coordination
Certifications & Qualifications
PACSCHESCCM
Industry Keywords
Healthcare AdministrationHIPAAMedicare GuidelinesMedicaid GuidelinesPatient Care
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, caregivers, healthcare providers, specialty pharmacies, and other stakeholders through resolution via email and inbound/outbound calls
- Provide education on access and reimbursement support tools, benefits, and program eligibility
- Educate healthcare provider offices on payer processes and procedures
- Build and maintain relationships with patients, prescribers, and client stakeholders
- Handle inbound calls according to program-approved FAQs and triage patients to appropriate resources
- Manage client and healthcare provider inquiries
- Provide personalized case management and communicate next steps for obtaining medication coverage and access
- Identify and communicate coverage requirements, including prior authorization, appeals, tier exceptions, and formulary exclusions
- Use electronic tools and manual investigations to determine benefits and payer coverage
- 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 proactively communicate re-verification or re-enrollment needs
- Identify and report adverse events, product complaints, special situation reports, and medical inquiries
- Document reimbursement activities in the Lynk system, including claims status, payments, and appeals
- Generate reports and analyses to identify trends and improvement opportunities
- Follow SOPs, corporate policies, and program operating procedures
- Perform additional assigned tasks and 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
- Minimum two years of experience in healthcare access delivery or management strongly preferred
- 5-10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education may be considered in lieu of degree
- Other certifications and five or more consecutive years of relevant experience may be considered; examples include PACS, CHES, or CCM
- Strong understanding of medical terminology and coding systems, including ICD-10, CPT, and HCPCS
- Knowledge of insurance processes, HIPAA, and Medicare/Medicaid guidelines
- Critical thinking and issue-resolution ability
- 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
- Ability to interact professionally with diverse stakeholders
- Bilingual skills are a plus
- Must meet all work-from-home criteria; remote eligibility is based on business need
- Ability to type at least 35 words per minute with 97% accuracy preferred
- Successful completion of a background check and, depending on position, 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