Medical Benefits Liaison

Mercalis•Morrisville, NC

4d•Hybrid

About The Position

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 Medical Benefit Liaison is responsible for working directly with provider offices to ensure a successful claim journey utilizing Mercalis’ medical benefit copay programs that need assistance for a variety of reasons including but not limited to: inquiries on how to submit a medical claim, troubleshooting issues, utilizing claims portal, investigating claim status, handling overrides/escalations or investigating/confirming payment receipt. The intention of this role is to be a growth and development role. You are part of the core team of one client and the intention is to collaborate within the team and be a team player. There is potential for growth within this team. This position is expected to be local and on site during initial training and remote thereafter with occasional on site workdays

Requirements

Bachelor’s degree and 2-4 years of medical benefit reimbursement/insurance, healthcare billing, physician office, health insurance processing preferred or in lieu of a degree, a High School diploma or equivalent with 4-6 years of medical benefit reimbursement/insurance, healthcare billing, physician office, health insurance processing
Strong understanding of medical claims processing, rejection troubleshooting, and provider medical claims workflows a plus
Strong sense of empathy and understanding for patient journey, always seeking to be an advocate with patient-centric mentality
Ability to provide exceptionally articulate verbal and written communication
Proficient with Microsoft products including MS Excel skills with the ability to review data sets to conclude outcome
Directly supporting and liaising between the client facing teams and technology & operational delivery teams
Ability to manage and prioritize workload based on competing demands
Customer Service – ability to collaborate with users to articulate requests, issues and resolution on time
Proven problem-solving abilities and strong organizational skills to successfully manage various types of escalations
Logical and efficient with attention to detail and committed follow through in communication with all stakeholders
Willing to work in a dynamic, fast paced environment and have the ability to multi-task with multiple escalations
Strong interpersonal skills, ability to work both independently and as part of a team
Initiative and strong work ethic critical
Ability to multitask and prioritize in a fast-paced environment
Excellent problem-solving and decision-making skills required
Attention to details
Strong organizational skills
All internal candidate with these qualifications are encouraged to apply

Nice To Haves

Strong understanding of medical claims processing, rejection troubleshooting, and provider medical claims workflows a plus

Responsibilities

Manages the day-to-day and end-to-end activities for multiple medical benefit copay programs as assigned
Responsible for managing escalations and overrides for sites and pharmacies. For rejected claims, MBL's will be responsible for creating tasks and follow up to ensure claims are pulled through. For approved escalations, MBLs will work with internal teams to submit claims for re-processing
Acting as main point of contact for all external stakeholders: sites, pharmacies, patients. Active and present on an inbound phone line as well as conducting regular outbound outreach
Assists all stakeholders by acting as an advocate delivering detailed information for various medical claim situations
Conduct outreach, verbal and written, to provider sites, patients and other stakeholders associated with supported programs to ensure turnaround times in line with client SLAs
Provides unparalleled customer service while serving as a service representative – empathy for this particular program and therapeutic area is paramount. Team member must have recognized work history of demonstrating empathy
Perform appropriate follow up tasks as needed to ensure successful claim journey
Consistently exercises discretion to analyze, interpret, make conclusions and decide what actions to take for each situation
Complete understanding of end-to-end medical claim processes to investigate scenarios and determine a resolution
Become SME on HCP Navigator Portal, training sites on how to utilize, troubleshoot basic issues, escalate to appropriate internal resources, and manage registration approvals, utilizing a set of tools to conduct validation research.
Support pharmaceutical reps with their sites as needed as it relates to their medical benefit program
Maintains a high level of ethical conduct regarding confidentiality and privacy
Maintains records in accordance with applicable standards and regulations to the programs/promotions
Participates in program team meetings and improvement/enhancement initiatives both current and future
Collaborates with external vendors and internal stakeholders as needed to properly document, escalate, and resolve issues
Participates in continuing education activities to remain knowledgeable in all programs/promotions and other related areas
Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events)
Utilize Mercalis’ leadership competencies as the driving force behind the team’s success
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