Customer Service Representative - Patient Services - EVERSANA : Job Details

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.

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

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

• Provide dedicated, personalized support delivered over the phone and via online portal.
• Complete investigations and answer questions regarding insurance benefits, including information about coverage and out-of-pocket costs. Collaborate with patients and doctors to assist with issues related to payments, reimbursements, payment denials, and appeals. Make outbound calls to customers for additional information.
• 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. Maintain a positive attitude and a helpful approach to customers and clients.
• Enter orders, change orders, track shipments, and enter customer notes to complete customer/consumer transactions. To include maintaining logs and records as required.
• Process patient assistance applications according to business rules of program.
• Other tasks and projects 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 with benefit verifications and prior authorizations
• Enter orders, change orders, and enter customer notes to complete customer/consumer transactions. To include 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.
• Focus on results in a professional, ethical, and responsible manner when dealing with customers, vendors, team members, and others.
• Accept being accountable and responsible in work practices and expectations. Delivers what is promised.
• Foster a collaborative, team-oriented attitude. Communicates 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

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.

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

• High School Diploma and 4 years' experience or Associate's Degree and 2 years' experience in healthcare setting
• Excellent oral, written, and interpersonal communication skills.
• Ability to multi-task.
• Positive attitude.
• Accurate and detail-oriented.
• Ability to work independently and function as a team player.
• Ability to work in a fast-paced, metric-driven environment, while remaining patient-minded.
• Strong computer skills with a working knowledge of Microsoft Word, Excel, and PowerPoint.

Preferred qualifications:

• Customer service and/or call center experience
• Patient assistance, reimbursement, and/or pharmacy benefit management experience
• Medical billing and coding experience

The physical and mental requirements along with the work environment characteristics described here are representative of those an individual encounters while performing the essential functions of this position.

Office: While performing the essential functions of this job, the employee is frequently required to reach, grasp, stand, and/or sit for long periods of time (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 usually moderately quiet, with frequent interruptions and multiple demands.