Patient Care Associate

Patient Support Specialist

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana.

A typical day in this role will include ownership of your patients cases from initiation to closure to include; benefit investigations, prior authorizations / denial appeals, determining financial qualifications for assistance programs and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our patented technology, PharmaCord Lynk) by using your critical thinking skills and your knowledge of the program and industry rules and standards. This role requires a high level of ownership, attention to detail and patient focus and will put your problem-solving skills to the test!

Key Responsibilities:

• Relationship Management
• Builds trusted relationships with patients, prescribers, client stakeholders through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients
• Manages all relationships in a manner that adheres to healthcare laws and regulations
• Communications
• Performs program welcome calls to patients
• Performs post Benefits Investigation calls to patients and physicians explaining coverage options
• Manages all client inquiries unable to be determined by client through reporting
• Manages HCP inquiries, as applicable, pursuant to business rules
• Inbound Call Management
• Manages inbound calls as directed by the program-approved FAQs
• Triage patients to internal or external resources as appropriate
• Personalized Case Management
• Provides personalized case management to patients and HCPs including outbound communication to HCPs and patients to communicate benefit coverage and next steps in obtaining coverage
• Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed
• Identifies and communicates patient's plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions
• Uses electronic resources to obtain benefit coverage outcome and if needed, outbound call to payers and HCPs to follow up on proper submission and/or outcome
• Coordinates nurse teach with field-based nurse educators, as applicable to program
• Supports adherence services through coordination of nurse follow up, as applicable to program
• Identifies peer support resources for patients
• Coordinates shipment of product through patient assistance program and/or bridge program from the PharmaCord pharmacy
• Proactively communicates needs for reverification of prior authorization or re-enrollment for patient assistance program
• Reports adverse events, Product complaints, special situation reports and/or medical inquiries received in accordance with SOPs and the Business Rules
• Documents all activities within the PharmaCord Lynk system in accordance with business requirements

Benefit Verification:

• Performing patient level benefits verifications as applicable for all major medical and pharmacy benefits plans.
• Completion of the template forms that provide patient level benefits Coverage Determination Summary.
• Coordination of prior authorizations based on payer guidelines and in compliance with law, regulation or guidance.

Patient Assistance:

• Review of patient assistance enrollment forms and any supporting documentation to assess patient eligibility for participation as per SOPs and program guidelines.
• Determination of patient's eligibility based upon program criteria for qualification.
• Communicating the patient's eligibility to the patient, healthcare provider, and/or consignment pharmacy.
• Answer and assist inbound callers through resolution utilizing answers to frequently asked questions or by warm transferring callers to other appropriate individuals.
• Actively listen to each customer, assess needs, and respond with demonstrated patience and courtesy.
• Review and identification of information that is missing and/or incorrect within program service requests/program applications.
• Reporting of Adverse Events/ Product Complaint inquiries received in accordance with SOP and good manufacturer practices.
• Provides timely feedback to the company regarding service failures or customer concerns
• Effectively uses our internal technology platform, Lynk, to complete claims processing and keep workflows moving.
• Communicate with key medical practice accounts, sales representatives regarding the status of cases. Provide consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy.
• Expected to be patient focused and committed to providing the highest quality customer service all while maintaining a sense of compliance and commitment to abiding by company policies and procedures.
• 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
• Self-awareness of your own emotions and the potential impact on others
• 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
• Takes responsibility for performance
• Adapts and handles change with flexibility
• Is innovative and open to new ideas
• Achievement driven; constant striving to improve or to meet a standard of excellence
• Aligns 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
• Clear and concise communication
• Positive attitude!
• Bachelor's degree preferred
• Customer service and/or healthcare industry experience is preferred
• Bi-lingual in English and Spanish or Chinese/Mandarin is a plus
• This is an office-based position, the ability to sit for extended periods of time is necessary
• Although very minimal, flexibility to travel as needed is preferred

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?

• 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