Patient Support Representative

2 weeks ago

Mason, United States EVERSANA Full time
Job Overview

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 who provide innovative commercialization services to the life sciences sector. We partner with more than 650 clients, ranging from pioneering biotech startups to established pharmaceutical firms, delivering products, services, and solutions that facilitate the introduction of groundbreaking therapies to the market and support the patients who rely on them.

Position Summary:
The Patient Support Representative plays a crucial role in engaging with patients, healthcare professionals, and payers by offering reimbursement assistance related to benefit coverage, prior authorizations, claim denials, appeals, and general inquiries.

Key Responsibilities:
Our team members are expected to achieve outstanding business outcomes through collaboration. Responsibilities include:

  • Delivering personalized support via phone, CRM, and email.
  • Conducting thorough investigations and providing answers 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 the triage process.
  • Maintaining a positive demeanor and a customer-centric approach.
  • Handling enrollment intake for all incoming requests.
  • Engaging in continuous quality improvement and training initiatives.
  • Performing additional duties as assigned.

Job Expectations:
Responsibilities include:

  • Supporting callers with benefit verifications and inquiries related to coverage and prior authorizations.
  • Triage inquiries to the appropriate third-party support centers.
  • Maintaining professionalism and ethical standards while interacting with patients, caregivers, and team members.
  • Being accountable for work practices and delivering on commitments.
  • Fostering a collaborative and communicative team environment.
  • Utilizing innovative thinking to address and resolve customer issues.
  • Seeking assistance when necessary to solve work-related challenges.
  • Adhering to all company and client policies and procedures.
  • Exhibiting excellent attendance and reliability.
  • Willingness to work rotating shifts as required.

Qualifications:
The ideal candidate will possess:

  • Strong experience in pharmacy reimbursement, particularly with prior authorization processes.
  • Experience in conducting benefit verifications with payers, preferably for retail prescription drug products.
  • Knowledge of healthcare administration, billing, and reimbursement procedures.
  • Familiarity with retail pharmacy operations is preferred.
  • Excellent communication skills, both verbal and written.
  • Ability to manage multiple tasks effectively.
  • A positive and detail-oriented attitude.
  • Capability to work independently while being a team player.
  • Proficiency in Microsoft Word, Excel, and PowerPoint.

Preferred Qualifications:
Experience in customer service or contact center environments is advantageous.

Physical and Mental Demands:
This role requires the ability to perform essential functions in an office environment, including prolonged periods of sitting, standing, and walking, as well as occasional lifting of up to 25 pounds.

Our Cultural Beliefs:
At EVERSANA, we are committed to diversity, equity, and inclusion, recognizing that these values are integral to our success. We are an Equal Opportunity Employer, and we celebrate the diverse backgrounds and experiences of our employees.

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