Care coordinator

As a Care Coordinator, you provide inbound and outbound phone support and may serve as the primary contact for payers, patients, caregivers, specialty pharmacies, site of care centers, specialty distributors, pharmacy compounders, and providers. You will facilitate a collaborative process that gauges, coordinates, and monitors patient benefits, product orders and appointment coordination with the purpose of facilitating the overall patient journey. This includes utilizing services offered through the Patient Support Program on behalf of a manufacturer (client). The primary function is to provide unparalleled customer service to key internal and external stakeholders as a dedicated contact by coordinating resources, exchanging information, and ensuring appropriate delivery of services.

Key Responsibilities:

• Care Coordinator may be regionally aligned and will serve as an expert on all aspects of benefit coordination, and other forms of available support and will be responsible for handling healthcare provider and/or patient interactions
• May serve as an advocate to patients regarding eligibility requirements, program enrollment, affordability support, and general access for prescribed therapy
• Establishes relationships, develop trust, and maintain rapport with healthcare providers and/or patients
• Serves as 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
• Strong working knowledge and ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD); with expertise in Medicare Part B
• Navigates through payer challenges by asking appropriate questions to obtain the necessary result
• Acts as an assigned liaison to client contacts (e.g., regional contact for sales representatives)
• Maintains records in accordance with applicable standards and regulations to the programs/promotion
• Follows program guidelines and escalates complex cases according to SOPs, Call Guides, and other program materials.
• Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events, safety complaints as per program SOPs) – (specific to program/client requirements) through Inbound and Outbound calling
• Liaison between Program Management, other internal stakeholders, and healthcare providers
• Provides unparalleled customer service, with attention to detail, while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commits to the appropriate use of resources
• Works with all levels of Program Management on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction, coordination challenges and program effectiveness
• Understands the nature of the disease states of patients of the program
• Assesses situations to act and intervene where needed to obtain a timely result
• Maintains a high level of ethical and professional conduct regarding confidentiality and privacy
• Helps maintain team morale by consistently demonstrating a positive attitude and strong work ethics
• Utilizes the necessary resources for conflict resolution as needed
• 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 by Project Management
• Utilize Valeris’ values as the driving force behind the team’s success
• On time adherence to training deadlines for all corporate policies and procedures
• Ensure all SOPs are followed with consistency
• Perform additional tasks or projects as assigned

Skills

customer support, insurance coverage, call center, insurance verification, crm

Top Skills Details

customer support, insurance coverage, call center, insurance verification

Additional Skills & Qualifications

• Associate or bachelor’s degree and 2 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing preferred, or in lieu of a degree, a High School diploma or equivalent with 5 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing
• Call Center/HUB or customer service experience with progressive levels of responsibility within a service driven environment required
• Excellent communication skills; orally and in writing
• Strong working knowledge of prior authorization and appeals is required
• Strong knowledge of medical and pharmacy insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related benefit coordination experience
• Proficient with Microsoft products

Technology must haves:

Agents are expected to have the appropriate internet bandwidth to support Valeris systems. It is critical that they have computer experience. Customer Relationship Management (CRM) software Multi-line telephone Multi-system computer experience (examples; double monitors, use of multiple applications at the same time) Culture of excellence – productivity focused and drive for development/growth within role. Give and/or receive feedback to and/or from peers and/or leaders. Team success – partner with peers for successful completion of team requirements. Adaptable to change.

The Care Coordinators are expected to be able to thrive in a fast-paced environment while managing multiple priorities and meeting established deadlines. Strong attention to detail and accuracy are essential, with a consistent focus on quality and following established processes. The individual should demonstrate the ability to work independently, exercise sound judgment, take ownership of responsibilities, and proactively address issues or seek assistance when needed. Candidates should have HUB or Patient Services experience.