Program Specialist II

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 through next-generation commercialization services for the life sciences industry. Our global team of more than 7,000 employees serves over 650 clients, ranging from innovative biotech start-ups to established pharmaceutical companies. We embrace diversity in backgrounds and experiences, believing our people make all the difference in cultivating an inclusive culture.

About the role

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.

Schedule

Must have open availability between 8:00 AM and 8:00 PM EST, based on program and business needs. Schedule may vary and will be assigned within the program operating hours. Weekend availability is required.

• Monday through Friday: 8:00 AM to 8:00 PM EST
• Saturday and Sunday: 9:00 AM to 5:00 PM EST

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 a 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, including maintaining logs and records as required.
• Process patient assistance applications according to business rules of the program.
• 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.
• Foster a collaborative, team-oriented attitude and communicate effectively 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.
• Other tasks and projects as assigned.

Requirements

• High School Diploma and 4 years’ experience or Associate’s Degree and 2 years’ experience in a healthcare setting.
• Excellent oral, written, and interpersonal communication skills.
• Ability to multitask.
• Positive attitude and detail-oriented.
• 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.

Benefits

EVERSANA is committed to providing competitive salaries and benefits for all employees. Compensation will be determined based on relevant experience, other job-related qualifications/skills, and geographic location. More information about EVERSANA’s benefits package can be found at eversana.com/careers.

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.