Senior Patient Support Specialist, Patient Solutions & Support Programs

The businesses of Merck KGaA, Darmstadt, Germany•Boston, MA

4d•$30 - $47

About The Position

The Senior Patient Support Specialist delivers prompt, professional phone assistance to patients, caregivers, and providers regarding specialty medication enrollment, access barriers, and affordability solutions, with a target of first-call resolution. The role guides stakeholders through benefit investigations, prior authorizations, appeals, copay assistance, and financial aid programs to clarify coverage and out-of-pocket costs. This position serves as the primary point of contact for complex reimbursement challenges, conducts root-cause analysis, and works with insurance verification vendors, internal partners, and cross-functional teams to streamline workflows. It requires thorough documentation of case interactions, patient data, and coverage updates in accordance with program protocols and strict adherence to HIPAA and regulatory requirements. The specialist also provides informal mentorship and procedural guidance to Patient Support Specialists, identifies operational bottlenecks and proposes solutions, assists leadership with case reviews and team performance metrics, and communicates operational updates between frontline staff and management. The role partners across organizational levels to foster a culturally competent, inclusive, patient-first team environment. The shift is Monday through Friday, 11:30 a.m. to 8 p.m. The position does not offer work authorization sponsorship; external applicants must be eligible to work in the United States.

Requirements

Bachelor’s degree in any discipline and at least 1 year of reimbursement and/or customer care experience in a medical, health insurance, or pharmacy technician role; OR
High school diploma or GED and at least 4 years of reimbursement and/or customer care experience in a medical, health insurance, or pharmacy technician role.

Nice To Haves

Experience with Salesforce or SFDC.
Proficiency with Microsoft Suite.
Data entry experience.
A collaborative, winning mindset and customer-centric approach.
Strong organizational skills.
Excellent verbal and written communication skills.
Comfort using multiple systems simultaneously.
Ability to thrive in a fast-paced, high-volume environment.
Empathy, prioritization skills, and flexibility.
Bilingual English and Spanish.

Responsibilities

Provide prompt, professional phone assistance to patients, caregivers, and providers about specialty medication enrollment, access barriers, and affordability solutions, targeting first-call resolution.
Guide stakeholders through benefit investigations, prior authorizations, appeals, copay assistance, and financial aid programs to clarify coverage and out-of-pocket costs.
Resolve complex reimbursement challenges by conducting root-cause analysis and providing solution-focused support.
Collaborate with insurance verification vendors, internal partners, and cross-functional teams to streamline workflows and maintain operational alignment.
Comply with HIPAA and regulatory requirements and document case interactions, patient data, and coverage updates according to program protocols.
Provide informal mentorship, procedural guidance, and best practices to Patient Support Specialists on complex workflows.
Identify operational bottlenecks from frontline trends and recommend proactive solutions and feedback to improve service quality.
Assist leadership in reviewing case handling, monitoring team performance metrics, and maintaining service consistency and compliance.
Communicate performance updates, operational changes, and improvement areas between frontline staff and management.
Partner across organizational levels with cultural competence to foster an inclusive, patient-first team environment aligned with organizational goals.