Pharmacy Technician

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 by an employee with a disability, unless such accommodation would cause an undue hardship for EVERSANA . If reasonable accommodation is needed to perform the essential functions of your job position, please contact Human Resources.
EXPECTATIONS OF THE JOB:

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Travel: 0%.

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Hours: 40 hours per week, 5 days per week.

- Serve as the primary point of contact for healthcare providers and inbound callers, obtaining complete patient enrollment and insurance information while utilizing critical and creative thinking to effectively resolve customer and work-related issues.

- Foster a collaborative, team-oriented approach in all interactions.

- Communicate effectively with others with clarity and transparency.

- Complete data entry tasks; enter and set up new patients in database; prescription processing.

- Complete manual and electronic patient benefit verifications.

- Recognize, assess, and appropriately escalate complex reimbursement or access-related issues.

- Achieve productivity, quality, attendance, and service-level performance metrics.

- Special project support as necessary.

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 liste