Reimbursement Specialist (Call Center)

Company Description

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. How? Our global team of more than 7,000 employees is committed to creating and delivering next-generation commercialization services to the life sciences industry. We are grounded in our cultural beliefs and serve more than 650 clients ranging from innovative biotech start-ups to established pharmaceutical companies. Our products, services and solutions help bring innovative therapies to market and support the patients who depend on them. Our jobs, skills and talents are unique, but together we make an impact every day. Join us!

Across our growing organization, we embrace diversity in backgrounds and experiences. Improving patient lives around the world is a priority, and we need people from all backgrounds and swaths of life to help build the future of the healthcare and the life sciences industry. We believe our people make all the difference in cultivating an inclusive culture that embraces our cultural beliefs.  We are deliberate and self-reflective about the kind of team and culture we are building. We look for team members that are not only strong in their own aptitudes but also who care deeply about EVERSANA, our people, clients and most importantly, the patients we serve.   We are EVERSANA.  

Job Description

THE POSITION:
The Reimbursement Specialist primarily responsible is to interface with Patients, HCPs and Payers by providing reimbursement support for activities related to benefit coverage, prior authorization, claim denials, appeals, triage to third party support centers and general inquiry.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Our employees are tasked with delivering excellent business results through the efforts of their teams.  These results are achieved by:

• Provide dedicated and personalized support delivered over the phone, CRM, and email.
• Complete investigations and answer questions regarding insurance benefits, including information about coverage and out-of-pocket costs.
• Assist with prior authorization and medical necessity processes, benefit verification and assistance in a manner that is consistent with industry best practice.
• Determine when call reason is best handled by third party support center and triage accordingly.
• Maintain positive attitude and a helpful approach to customers and clients.
• Conduct enrollment intake for all incoming inquiries.
• Participate in continuous quality improvements and training opportunities.
• All other duties as assigned.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

EXPECTATIONS OF THE JOB:

• Assist callers with benefit verifications and providing support related to coverage, out-of-pocket costs and prior authorizations as needed
• Triage to appropriate third party support centers
• Focus on results in a professional, ethical, and responsible manner when dealing with patients, caregivers, customers, vendors, team members, and others.
• Accepts being accountable and responsible in work practices and expectations. Delivers what is promised.
• Fosters a collaborative, team-oriented attitude. Communicates effectively with others with clarity and transparency.
• Uses innovative critical and creative thinking to evaluate and solve work and customer issues.
• Seeks assistance in solving work problems through collaboration and information seeking.
• Learn, understand and follow all company and client policies and procedures.
• Excellent attendance
• Must be able to work rotating 8 hour shifts Monday through Friday.

The above list reflects the general details necessary to describe the expectations of the position and shall not be construed as the only expectations that may be assigned for the position.

An individual in this position must be able to successfully perform the expectations listed above.

Qualifications

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES:

The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required.

• Strong pharmacy reimbursement experience, especially understanding of prior authorization process
• Experience conducting benefit verifications with payers preferably supporting retail prescription drug products.
• Knowledge of healthcare administration and specifically healthcare billing and reimbursement procedures and regulations
• Knowledge of Retail Pharmacy Operations preferred
• Excellent oral, written, and interpersonal communication skills.
• Ability to multi task.