Program Specialist II

EVERSANA•Mason, OH

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.

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
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
Assist with benefit verifications and prior authorizations
Enter orders, change orders, and enter customer notes to complete customer/consumer transactions. To include maintaining logs and records as required.
Act as the primary point of contact for healthcare providers to obtain complete patient enrollment and insurance information
Learn, understand and follow all company and client policies and procedures.
Focus on results in a professional, ethical, and responsible manner when dealing with customers, vendors, team members, and others.
Accept being accountable and responsible in work practices and expectations.
Delivers what is promised.
Foster a collaborative, team-oriented attitude.
Communicates effectively with others with clarity and transparency.
Use innovative critical and creative thinking to evaluate and solve work and customer issues.
Seek assistance in solving work problems through collaboration and information seeking.
Excellent attendance
The above list reflects the general details necessary to describe the expectations of the position and shall not be construed as the only expectations that may be assigned for the position. An individual in this position must be able to successfully perform the expectations listed above.