Executive Care Coordinator, Bilingual
New
V
ValerisHealthcare access
Source API remote eligibility restrictions: United States, 8:00 AM - 4:30 PM ET shift is required for this role.Full-TimeExecutive
Salary not disclosed
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Job Details
- Languages
- Must be fluent in both Spanish and English languages.
- Experience
- Two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is required. Minimum two years of experience in healthcare access delivery or management is strongly preferred.
- Required Skills
- HIPAA
Requirements
- Must be fluent in both Spanish and English.
- A bachelor's degree or higher is required; a healthcare administration, social science, or similar degree is preferred.
- In lieu of a degree, five or more years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is required.
- Two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is required.
- Two years of experience in healthcare access delivery or management is strongly preferred.
- Demonstrate a strong understanding of medical terminology, ICD-10, CPT, HCPCS, and insurance processes.
- Know healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
- Demonstrate attention to detail, organizational skills, and the ability to prioritize work in a fast-paced environment.
- Communicate effectively in writing and verbally with diverse stakeholders.
- Demonstrate critical thinking and issue-resolution ability.
- PACS, CHES, or CCM certification and five or more consecutive years of relevant experience may be considered.
- The 8:00 AM - 4:30 PM ET shift is required.
- Candidates who can type at least 35 words per minute with 97% accuracy are preferred.
- Flexibility to travel as needed is preferred; travel is expected to be minimal.
Responsibilities
- Build trusted relationships with patients, prescribers, and client stakeholders about reimbursement inquiries and challenges.
- Manage inbound and outbound calls with patients, caregivers, specialty pharmacies, and healthcare professionals.
- Complete benefit investigations and explain coverage options and next steps to patients and physicians.
- Identify and communicate coverage outcomes, prior authorization needs, appeals, tier exceptions, and formulary exclusions.
- Follow up with payers and healthcare providers on benefit coverage submissions and outcomes.
- Coordinate nurse education, adherence services, and peer support resources as applicable to the program.
- Track prior authorization reverification and patient re-enrollment needs.
- Identify and report adverse events, product complaints, special situation reports, and medical inquiries according to program procedures.
- Document reimbursement activities, claims status, payments, and appeals in the Lynk system.
- Generate reports and analysis to identify trends and opportunities for improvement.
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