Application Deadline: Monday July 7th @6pm EST

SHIFTS AVAILABLE ARE:

Monday - Friday

8a-5p EST

10a-7p EST

11a-8p EST

Training Hours: Monday - Friday 8a-5p EST

Mercalis is an integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Backed by proven industry expertise and results-driven technology, Mercalis helps navigate the complex life sciences marketplace by providing commercialization solutions to accelerate value and enhance patient lives.

Mercalis fosters a culture that encourages individuality and provides opportunities for creativity, growth, and success while fostering a team environment. We are a diversity-driven organization with an inclusive approach to delivering patient-centric solutions that, eliminate barriers for patients, and increase patient access to life altering medications.

The Senior Patient Navigator plays a critical role in ensuring patients have access to life-altering medications by supporting them through complex processes such as insurance verification, prior authorizations, and appeals. This position combines exceptional customer service, relationship management, and expertise in reimbursement practices to provide personalized support and ensure compliance with all healthcare regulations. The role also focuses on educating healthcare providers and patients on access, coverage, and reimbursement support. These roles will be regionally aligned to best support patients.

• Serves as the single point of contact and provides personalized case management for patients, caregivers, and healthcare providers (HCPs), including delivery of benefit investigations, prior authorization tracking, and appeal support.
• Educate patients, HCPs, and stakeholders on access and reimbursement processes, payer policies, and Mercalis programs (e.g., patient assistance programs, copay programs).
• Build and maintain trusted relationships with patients, prescribers, and client stakeholders by delivering accurate, timely, and compassionate support.
• Coordinate and collaborate with client field teams, following agreed upon business rules and guidelines
• Communicate benefit coverage options and next steps in the patient journey using clear and patient-friendly language.
• Leverage electronic tools to navigate and complete benefit investigations, ensuring payer coverage is secured for prescribed treatments.
• Ensure all activities comply with healthcare laws, regulations, and Mercalis standard operating procedures (e.g., HIPAA, insurance guidelines).
• Identify and escalate adverse events, product complaints, and special situation reports as required by the program.
• Document all activities in the Mercalis system, maintaining detailed and accurate records.
• Support adherence services, including patient education and coordinating nurse teaching as applicable.
• Participate in team meetings and ongoing training to stay updated on policies and procedures.
• Travel MAY BE required to our HQ in Morrisville, NC per client request (at most 4x per year, IF requested).

• Bachelor’s degree required, preferably in healthcare administration, social science, or a related field.
• In lieu of a degree, candidates may qualify with:
• 5–10 years of relevant experience in areas such as insurance reimbursement, patient access, direct patient care, or patient education, or
• Relevant certifications (e.g., PACS, CHES, or CCM) plus at least 5 consecutive years of related experience.
• Minimum two (2) years of experience in healthcare access delivery or management is strongly preferred.
• Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
• Ability to prioritize tasks and work efficiently in a fast-paced environment
• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
• Bilingual / Multilingual is a plus.

***For Internal Employees, Please Review and Note***

While this role shares similarities with an Executive Case Manager in terms of patient support and coordination, it carries a significantly higher level of complexity and visibility. This position requires navigating multiple systems simultaneously, maintaining strict adherence to client-defined processes, and operating under increased oversight from both internal quality teams and the client directly.

In addition to being more client-facing, this role demands elevated critical thinking and autonomy when working through decision trees, as the scenarios often involve more nuanced judgment calls and cross-functional collaboration. The expectations for this role are more strategic in nature and therefore require a higher level of performance, compliance, and accountability.

This position may also involve periodic travel—not only to client sites, but also to our Raleigh location—for meetings, training, and alignment sessions as part of ongoing program engagement and oversight responsibilities.

Why Work for Mercalis?

• Our Mission is rewarding and fulfilling (Patient Access to Life-Saving/Improving/Extending Medications/Treatments)
• We employ the best Talent and Tools from the Patient Access Industry (We are the Industry Leader)
• We monitor the market to ensure we offer competitive salaries and benefits. 
• 401K w/ 5% matching; day-1 vestment period
• 15 days PTO
• 8 Holidays + 2 Floating Days
• Health/Dental/Vision/Life; Coverage day-1
• Gym Reimbursement
• Volunteer Hours
• Flexibility/Hybrid/Remote**

*This is not an exhaustive list of benefits.  

*Benefits are subject to change 

** Some positions require onsite presence and/or structured hours/shifts

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