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, appeal denials, triage to specialty pharmacy and general inquiry. The position is also responsible for ensuring patient assistance program services are delivered and administered appropriately as agreed upon via work instructions and or standard operating procedures/business rules.

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 prior authorization assistance in a manner that is consistent with industry best practice.
• Determine network specialty pharmacy options and triage accordingly.
• Administer comprehensive searches for alternate reimbursement resources, such as state and federal assistance programs, and enrollment assistance for qualified patients.
• Maintain positive attitude and a helpful approach to customers and clients.
• Financial assistance screening which includes free goods, screen for third-party foundation support, and co-pay assistance.
• 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 with benefit verifications and prior authorizations as needed
• Triage to appropriate specialty pharmacies
• 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.

• Required to have 5 years’ experience conducting benefit verifications with payers supporting buy-and-bill products.
• Expert knowledge in patient assistance, reimbursement, medical benefit management, denials, and prior authorizations
• Knowledge of healthcare administration and specifically healthcare billing and reimbursement procedures and regulations
• Knowledge of Specialty Pharmacy Operations preferred
• Excellent oral, written, and interpersonal communication skills.
• Ability to multi task.
• Positive attitude.
• Accurate and detail-orientated.
• 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.
• Must possess, or have the ability to obtain, a Missouri pharmacy technician certification. 

PREFERRED QUALIFICATIONS:

• Customer service and/or contact center experience.
• Reimbursement/Patient Services experience.

PHYSICAL/MENTAL DEMANDS AND WORKING ENVIRONMENT:

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.

Additional Information

OUR CULTURAL BELIEFS:

Patient Minded I act with the patient’s best interest in mind.

Client Delight I own every client experience and its impact on results.

Take Action I am empowered and empower others to act now.

Grow Talent I own my development and invest in the development of others. 

Win Together I passionately connect with anyone, anywhere, anytime to achieve results.

Communication Matters I speak up to create transparent, thoughtful and timely dialogue.

Embrace Diversity I create an environment of awareness and respect.

Always Innovate I am bold and creative in everything I do.

From EVERSANA’s inception, Diversity, Equity & Inclusion have always been key to our success. We are an Equal Opportunity Employer, and our employees are people with different strengths, experiences, and backgrounds who share a passion for improving the lives of patients and leading innovation within the healthcare industry. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion, and many other parts of one’s identity. All of our employees’ points of view are key to our success, and inclusion is everyone's responsibility.

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