Healthcare Call Center Specialist

3 days ago


Chesterfield, Missouri, United States EVERSANA Company Full time
Job Description

The Program Specialist II will provide dedicated support to patients and healthcare providers for activities related to benefit coverage, payments, reimbursements, denials, and general inquiry phone calls through our patient services support center.

Key Responsibilities:
  • Provide personalized support delivered over the phone and via online portal to patients and healthcare providers.
  • Investigate and answer questions regarding insurance benefits, including information about coverage and out-of-pocket costs, and collaborate with patients and doctors to assist with issues related to payments, reimbursements, payment denials, and appeals.
  • 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.
  • 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.
  • Perform other tasks and projects as assigned.
Expectations of the Job:
  • Assist with benefit verifications and prior authorizations.
  • Enter orders, change orders, and enter customer notes to complete customer/consumer transactions, including 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.
  • Foster a collaborative, team-oriented attitude and communicate 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 and punctuality are expected.


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