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 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

• Completion of Bachelor's degree (or higher) required.
• A degree in healthcare administration, social science or similar related fields is strongly preferred.
• Minimum two (2) years of experience in healthcare access delivery or management is strongly preferred.
• Five (5) to ten (10) years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education experience will be considered in lieu of degree.
• Other certifications and five (5) or more consecutive years of experience in relevant field could be considered. Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager).
• 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.