Mercalis · 18 hours ago
Reimbursement Specialists
United States
Full-time
Remote
Entry, Mid Level
$50K/yr - $300K/yr
4+ years expValeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions spanning the healthcare value chain. As a Reimbursement Case Manager, you will provide inbound and outbound phone support, serving as the primary contact for patients, caregivers, and providers while facilitating access to life-saving treatments through the Patient Support Program.
Clinical TrialsHealth CareManufacturingMarketingPharmaceutical
Responsibilities
Reimbursement Case Managers may be regionally aligned and will serve as an expert on reimbursement, co-pay, foundation assistance, PAP issues, and other forms of available support and will be responsible for handling patient and healthcare provider interactions
Serve as an advocate to patients regarding eligibility requirements, program enrollment, reimbursement process, affordability support, and general access for prescribed therapy
Establish relationships, develop trust, and maintain rapport with patients, payers and healthcare providers
Serve as direct point of contact to health care providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient
Serve as a resource for patients and healthcare professionals to verify insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals
Evaluate program enrollment forms for data integrity
Responsible for insurance benefit investigations, and triage cases according to program standard operating procedures
Follow program guidelines and escalate complex cases according to program policy, SOPs, Call Guides, and other program materials
Working case management system, documenting status/background in case notes, communicating patient benefits, assisting in the PA/Appeals process and like responsibilities
Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD)
Act as an assigned liaison to client contacts (e.g., regional contact for sales representatives), Program Management, other internal stakeholders and Healthcare Providers
Maintain records in accordance with applicable standards and regulations to the programs/promotions
Provide unparalleled customer service while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources
Works with the Program Manager, on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction and program effectiveness
Understand health and disease states of patients of the programs
Maintains a high level of ethical conduct regarding confidentiality and privacy
Help maintain team morale by consistently demonstrating positive attitude
On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
Ensure all SOPs are followed with consistency
Conducts miscellaneous tasks or projects as assigned Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events) – (specific to program/client requirements)
Qualification
Required
Ability to communicate effectively both orally and in writing
Knowledge of medical insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related experience
Excellent problem-solving and decision-making skills required
Attention to detail and committed follow through in communication with patients, providers and internal stakeholders
Strong organizational skills
Willing to work in a dynamic, fast paced environment and have the ability to multi-task and adapt to change while adhering to Program Standards
Strong interpersonal skills, ability to work both independently and as part of a team, ability to jump in and help others as needed
Empathetic listening skills in order to interact effectively with patients and providers
Punctual, reliable with strong attendance record
Proficient with Microsoft products
Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD)
Maintain records in accordance with applicable standards and regulations to the programs/promotions
Provide unparalleled customer service while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources
Works with the Program Manager, on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction and program effectiveness
Understand health and disease states of patients of the programs
Maintains a high level of ethical conduct regarding confidentiality and privacy
Help maintain team morale by consistently demonstrating positive attitude
On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
Ensure all SOPs are followed with consistency
Conducts miscellaneous tasks or projects as assigned Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events) – (specific to program/client requirements)
Preferred
Associate or Bachelor's degree preferred; or a minimum of 4 years of call center or customer service experience with progressive levels of responsibility within a service driven environment
Flexibility to travel as needed is preferred
Benefits
Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
Additional health support, including telehealth and Employee Assistance Program (EAP) services
Company match on Health Savings Account contributions
Free Basic Life and AD&D coverage equal to your 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% you contribute, with immediate vesting
Paid Time Off (PTO) and Sick Leave to support work-life balance
Team members receive nine paid holidays plus two floating holidays
Opportunities for advancement in a company that supports personal and professional growth
A challenging, stimulating work environment that encourages new ideas
Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
A mission-driven, inclusive culture where your work makes a meaningful impact
Company
Mercalis
Mercalis is an integrated life sciences commercialization that offers comprehensive solutions across the healthcare value chain.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2025-03-12Acquired
2011-05-18Series Unknown
Leadership Team
Scott Dulitz
Chief Executive Officer
Recent News
2026-01-20
2025-07-04
Company data provided by crunchbase