**SHIFTS AVAILABLE: OPTIONS OF 8A-5P EST OR 10A-7P EST M-F (12 OPENINGS FOR THIS REQUISITION)**

***CANDIDATE MUST BE ABLE TO ACCOMMODATE ON-SITE TRAINING 6/30/25-8/22/25 AT OUR HQ IN MORRISVILLE, NC - REMOTE AFTER TRAINING.***

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.

As a Reimbursement Case Manager, you will facilitate a collaborative process that gauges, coordinates, and monitors patient needs and appropriately facilitate a patient’s journey utilizing services offered through the Patient Support Program on behalf of a manufacturer.  These services include handling the day-to-day activities within reimbursement services, such as daily interactions with healthcare insurance companies to verify the financial aspects of healthcare services to ensure patients have access to life saving treatments they need.

• Reimbursement Case Managers will serve as an expert on reimbursement, co-pay, foundation assistance
• Reimbursement Case Managers will serve as an expert on all aspects of benefit coordination, and other forms of available support.
• 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
• Serve as a resource for patients and healthcare professionals to verify insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals
• Escalate complex cases according to program policy and procedures.
• 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, assisting in the PA/Appeals process and like responsibilities
• Maintain records in accordance with applicable standards and regulations to the programs/promotions
• Identify and report pharmacovigilance information as required by client(s)(i.e., Adverse Events)-(specific to program/client requirements)
• 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, payer feedback/satisfaction and program effectiveness
• Understand the 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)
• Other responsibilities assigned based on specific to program/client requirements.

• 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
• Ability to communicate effectively both 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
• 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
• Ability to adapt to change while maintaining Program standards
• Strong team players are willing to jump in and help other team members when needed
• Punctual, reliable with strong attendance record
• Proficient with Microsoft products

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