Program Specialist II

3 weeks ago

Chester, Virginia, United States EVERSANA Full time
Job Description

The Position:

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.

Essential Duties and Responsibilities:
  • Provide personalized support delivered over the phone and via online portal.
  • Investigate and answer questions regarding insurance benefits, including information about coverage and out-of-pocket costs. Collaborate with patients and healthcare providers 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.
  • Process patient assistance applications according to business rules of the program.
Expectations of the Job:
  • Assist with benefit verifications and prior authorizations.
  • Enter orders, change orders, and enter customer notes to complete customer/consumer transactions.
  • 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.
Qualifications:
  • 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 and work independently.
  • Positive attitude and accurate attention to detail.
Work Perks:
  • Competitive wages and above-market salary structures.
  • Generous employer matching retirement solutions.
  • Leading health, dental, and vision insurance products.
  • Employer-funded tuition reimbursement.
  • Global workplace flexibility and remote work options.
  • Generous paid time off and company holidays.
  • Company-provided training and development opportunities.

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