Job at a glance
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 Program Specialist II (PSII) works independently on routine and moderately complex cases and exercises judgment within established program guidelines. As the primary case-management and benefits verification specialist for assigned programs, the PSII manages patient enrollment activities, benefit investigations, insurance verification, and routine patient access issues while serving as a primary point of contact for patients, providers, and payers.
Complex reimbursement, prior authorization, appeals, and escalation issues are referred to the Program Specialist III or next level leader. The PSII delivers an exceptional patient and provider experience through inbound and outbound telephony support, document triage, follow-up on missing information, data entry, and patient benefit verification activities. The PSII ensures adherence to program business rules, company policies and procedures, and HIPAA guidelines.
ESSENTIAL DUTIES AND RESPONSIBILITIES: Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by the following actions: Process all incoming documents including uploading and processing data within the appropriate patient database(s). Handle inbound and outbound calls and document interactions. Triage calls as necessary and route them appropriately, with the goal of achieving one touch caller resolution.
Recognize issues requiring escalation in accordance with program guidelines. Complete benefit investigations and eligibility assessments; research coverage requirements, out-of-pocket costs, and payer requirements to facilitate patient access to therapy. Escalate complex reimbursement, appeals, and prior authorization issues to Program Specialist III or next level leader. Coordinate with patients, providers, and payers to obtain missing information and resolve routine access barriers.
Independently manage patient cases from intake through benefit verification completion, ensuring accurate documentation, timely follow-up, and adherence to program requirements. Maintain the confidentiality and integrity of protected health information; follows HIPAA security policies and procedures. Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.
All other duties as assigned.   Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of EVERSANA to provide reasonable accommodation when requested