Program Specialist II - job 1 of 3

At EVERSANA, we are proud to be certified as a Great Place to Work across the globe. We’re fueled by our vision to create a healthier world. How? Our global team of more than 7,000 employees is committed to creating and delivering next-generation commercialization services to the life sciences industry. We are grounded in our cultural beliefs and serve more than 650 clients ranging from innovative biotech start-ups to established pharmaceutical companies. Our products, services and solutions help bring innovative therapies to market and support the patients who depend on them. Our jobs, skills and talents are unique, but together we make an impact every day. Join us!

Across our growing organization, we embrace diversity in backgrounds and experiences. Improving patient lives around the world is a priority, and we need people from all backgrounds and swaths of life to help build the future of the healthcare and the life sciences industry. We believe our people make all the difference in cultivating an inclusive culture that embraces our cultural beliefs.  We are deliberate and self-reflective about the kind of team and culture we are building. We look for team members that are not only strong in their own aptitudes but also who care deeply about EVERSANA, our people, clients and most importantly, the patients we serve.   We are EVERSANA.  

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.

EXPECTATIONS OF THE JOB:

• 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.

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES:

The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required.

• 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.

PREFERRED QUALIFICATIONS:

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

OUR CULTURAL BELIEFS:

Patient Minded I act with the patient’s best interest in mind.

Client Delight I own every client experience and its impact on results.

Take Action I am empowered and empower others to act now.

Grow Talent I own my development and invest in the development of others. 

Win Together I passionately connect with anyone, anywhere, anytime to achieve results.

Communication Matters I speak up to create transparent, thoughtful and timely dialogue.

Embrace Diversity I create an environment of awareness and respect.

Always Innovate I am bold and creative in everything I do.

Our team is aware of recent fraudulent job offers in the market, misrepresenting EVERSANA. Recruitment fraud is a sophisticated scam commonly perpetrated through online services using fake websites, unsolicited e-mails, or even text messages claiming to be a legitimate company. Some of these scams request personal information and even payment for training or job application fees. Please know EVERSANA would never require personal information nor payment of any kind during the employment process. We respect the personal rights of all candidates looking to explore careers at EVERSANA.

From EVERSANA’s inception, Diversity, Equity & Inclusion have always been key to our success. We are an Equal Opportunity Employer, and our employees are people with different strengths, experiences, and backgrounds who share a passion for improving the lives of patients and leading innovation within the healthcare industry. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion, and many other parts of one’s identity. All of our employees’ points of view are key to our success, and inclusion is everyone's responsibility.

Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of EVERSANA to provide reasonable accommodation when requested by a qualified applicant or candidate with a disability, unless such accommodation would cause an undue hardship for EVERSANA. The policy regarding requests for reasonable accommodations applies to all aspects of the hiring process. If reasonable accommodation is needed to participate in the interview and hiring process, please contact us at [email protected].

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