Patient Support Specialist

1 week ago

Mason, Ohio, United States EVERSANA Company Full time
Company Overview

At EVERSANA, we take pride in being recognized as a Great Place to Work globally. Our mission is to foster a healthier world through our dedicated team of over 7,000 professionals. We provide innovative commercialization services tailored for the life sciences sector, serving more than 650 clients, from emerging biotech firms to established pharmaceutical organizations. Our comprehensive solutions are designed to facilitate the market introduction of groundbreaking therapies and support the patients who rely on them.

Position Overview:
The primary role of the Patient Support Specialist is to engage with Patients, Healthcare Providers (HCPs), and Payers, offering reimbursement assistance related to benefit coverage, prior authorizations, claim disputes, appeals, and general inquiries.

Key Responsibilities:
Our team members are expected to achieve exceptional business outcomes through collaborative efforts. Responsibilities include:
  • Delivering personalized support via phone, CRM, and email.
  • Conducting thorough investigations and responding to inquiries regarding insurance benefits, including coverage details and out-of-pocket expenses.
  • Assisting with prior authorization and medical necessity processes, ensuring compliance with industry best practices.
  • Identifying when inquiries should be directed to third-party support centers and managing referrals accordingly.
  • Maintaining a positive demeanor and a customer-centric approach.
  • Facilitating enrollment intake for all incoming requests.
  • Engaging in continuous quality improvement initiatives and training opportunities.
  • Performing additional duties as assigned.
Reasonable accommodations may be provided to enable individuals with disabilities to fulfill the essential functions of this role.

Job Expectations:
  • Assist callers with benefit verifications and provide support related to coverage, out-of-pocket expenses, and prior authorizations as necessary.
  • Direct inquiries to the appropriate third-party support centers.
  • Demonstrate professionalism, ethics, and responsibility when interacting with patients, caregivers, clients, vendors, and colleagues.
  • Take accountability for work practices and deliver on commitments.
  • Foster a collaborative, team-oriented environment and communicate effectively with clarity and transparency.
  • Utilize innovative critical thinking to address and resolve customer issues.
  • Seek assistance collaboratively to solve work-related challenges.
  • Learn and adhere to all company and client policies and procedures.
  • Exhibit excellent attendance.
  • Be available to work rotating 8-hour shifts from Monday to Friday.
The above responsibilities reflect the general expectations of the position and are not exhaustive.

An individual in this role must be capable of successfully performing the outlined expectations.

Qualifications:
The following qualifications are representative of the experience, education, knowledge, skills, and abilities required:
  • Strong experience in pharmacy reimbursement, particularly with prior authorization processes.
  • Experience in conducting benefit verifications with payers, preferably for retail prescription drug products.
  • Understanding of healthcare administration, including billing and reimbursement procedures and regulations.
  • Familiarity with Retail Pharmacy Operations is preferred.
  • Excellent verbal, written, and interpersonal communication skills.
  • Ability to manage multiple tasks effectively.
  • Positive attitude and attention to detail.
  • Capability to work independently while also being a team player.
  • Ability to thrive in a fast-paced, metrics-driven environment while remaining patient-focused.
  • Proficient computer skills, including a working knowledge of Microsoft Word, Excel, and PowerPoint.
Preferred Qualifications:
  • Experience in customer service and/or contact center environments.
  • Background in reimbursement or patient services.
Physical and Mental Demands:
The physical and mental requirements, along with the work environment characteristics described here, are representative of those encountered while performing the essential functions of this position.

Office Environment: While performing the essential functions of this job, the employee is frequently required to reach, grasp, stand, and/or sit for extended periods (up to 90% of the shift), walk, talk, and hear; occasionally required to lift and/or move up to 25 pounds. The noise level in the work environment is typically moderately quiet, with frequent interruptions and multiple demands.

Our Cultural Beliefs:
Patient Focused: I act with the patient's best interest in mind.
Client Satisfaction: I take ownership of every client experience and its impact on results.
Proactive: I am empowered and empower others to take action.
Talent Development: I take responsibility for my growth and invest in the development of others.
Collaborative Success: I connect passionately with anyone, anywhere, anytime to achieve results.
Effective Communication: I engage in transparent, thoughtful, and timely dialogue.
Diversity Embraced: I foster an environment of awareness and respect.
Innovation Driven: I approach every task with boldness and creativity.

At EVERSANA, we recognize that Diversity, Equity, and Inclusion are essential to our success. We are an Equal Opportunity Employer, and our workforce is composed of individuals with diverse strengths, experiences, and backgrounds, all united by a commitment to enhancing patient lives and driving innovation in healthcare.

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