• Assist with determining coverage and access options available for a specific medication or procedure
• Collect and analyze information and resources related to local, regional or national payer coverage or claim submission process
• Clearly articulate complex reimbursement and billing information to HCPs, their office staff and/or patients to ensure understanding of coverage benefit and financial responsibility
• Educate provider offices on local and regional payer coverage policies, issues, coding changes, and appropriate claims submission processes
• Educate offices about the medical necessity requirements for coverage and provide education support for the office to submit pre-determinations, appeals and/or peer to peer reviews with payors, as applicable
• Assist offices to understand payor denied or underpaid claims and provide education, as applicable, for the office to resolve of rejected, denied or underpaid claims
• Educate HCPs, their office staff and/or patients on appropriate resources for questions about co-pay, coinsurance, out of pocket costs, deductibles and other financial assistance or coverage related questions
• Serve as a patient advocate and enhance the customer experience for all callers by acting as a single point of contact and a compassionate voice for all providers and patients
• 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

Qualifications:

• Detail oriented
• Professional telephone etiquette
• Basic computer knowledge
• Ability to multitask effectively
• Ability to recognize emotions and their effects
• Sureness about self-worth and capabilities
• Manage disruptive impulses
• Maintain standards of honesty and integrity
• Take responsibility for performance
• Be adaptable and handle change with flexibility
• Be innovative and open to new ideas
• Achievement driven; constant striving to improve or to meet a standard of excellence
• Align with the goals of the group or organization
• Ready to take initiative and act on opportunities
• Be optimistic and pursue goals persistently despite obstacles and setbacks
• Be service oriented and anticipate, recognize and meet needs of others, including patients and care partners
• Communicate clearly and send clear messages
• Ability to consume complex coverage policy changes and convert complexity to educate lay persons
• Adaptability to change
• Personal initiative and commitment to team and organizational goals
• Ability to work effectively within a team
• A positive attitude!
• Minimum of (two) 2 years’ of billing and coding experience is preferred
• Bachelor’s degree in arts and sciences, social work, public health administration or a related field preferred
• Billing and coding diploma or certificate strongly preferred
• High School diploma or equivalent is required
• Strong understanding of medical terminology background is preferred
• Background working directly within physician practices or outpatient clinics billing commercial insurances, Medicare, and Medicaid preferred
• Bi-lingual in English and Spanish or Chinese/Mandarin is a plus

Physical Demands & Work Environment:

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.
• Although very minimal, flexibility to travel as needed is preferred.
• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

Why Work for Valeris?

• We’re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:
• 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