Program Specialist II

EVERSANA • Mason, OH

7d

About The Position

THE POSITION:
The Program Specialist II will provide dedicated support to patients and doctors for activities related to benefit coverage, payments, reimbursements, denials and general inquiry phone calls through our patient services support center.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by:
Provide dedicated, personalized support delivered over the phone and via online portal.
Complete investigations and answer questions regarding insurance benefits, including information about coverage and out-of-pocket costs. Collaborate with patients and doctors to assist with issues related to payments, reimbursements, payment denials, and appeals. Make outbound calls to customers for additional information.
Assist with prior authorization and medical necessity processes, benefit verification and prior authorization assistance.
Administer comprehensive searches for alternate reimbursement resources, such as state and federal assistance programs, and enrollment assistance for qualified patients.
Respond to inquiries from customers, sales representatives and business partners, and follow up on requests in a timely, courteous and professional manner. Maintain positive attitude and a helpful approach to customers and clients.
Enter orders, change orders, track shipments, and enter customer notes to complete customer/consumer transactions. To include maintaining logs and records as required.
Process patient assistance applications according to business rules of program.
Other tasks and projects as assigned
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Requirements

• High School Diploma and 4 years’ experience or Associate’s Degree and 2 years’ experience in healthcare setting
• Excellent oral, written, and interpersonal communication skills.
• Ability to multi task.
• Positive attitude.
• Accurate and detail-orientated.
• Ability to work independently and function as a team player.
• Ability to work in a fast paced, metric driven environment, while remaining patient minded.
• Strong computer skills with a working knowledge of Microsoft Word, Excel, and PowerPoint.

Nice To Haves

• Customer service and/or call center experience
• Patient assistance, reimbursement and/or pharmacy benefit management experience
• Medical billing and coding experience

Responsibilities

• Provide dedicated, personalized support delivered over the phone and via online portal.
• Complete investigations and answer questions regarding insurance benefits, including information about coverage and out-of-pocket costs.
• Collaborate with patients and doctors to assist with issues related to payments, reimbursements, payment denials, and appeals.
• Make outbound calls to customers for additional information.
• Assist with prior authorization and medical necessity processes, benefit verification and prior authorization assistance.
• Administer comprehensive searches for alternate reimbursement resources, such as state and federal assistance programs, and enrollment assistance for qualified patients.
• Respond to inquiries from customers, sales representatives and business partners, and follow up on requests in a timely, courteous and professional manner.
• Maintain positive attitude and a helpful approach to customers and clients.
• Enter orders, change orders, track shipments, and enter customer notes to complete customer/consumer transactions. To include maintaining logs and records as required.
• Process patient assistance applications according to business rules of program.
• Other tasks and projects as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees