Program Specialist II

Summary

Program Specialist IIThe 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.Essential duties and responsibilities include delivering excellent business results through the efforts of their teams by:Providing dedicated, personalized support delivered over the phone and via online portal.Completing investigations and answering questions regarding insurance benefits, including information about coverage and out-of-pocket costs. Collaborating with patients and doctors to assist with issues related to payments, reimbursements, payment denials, and appeals. Making outbound calls to customers for additional information.Assisting with prior authorization and medical necessity processes, benefit verification and prior authorization assistance.Administering comprehensive searches for alternate reimbursement resources, such as state and federal assistance programs, and enrollment assistance for qualified patients.Responding to inquiries from customers, sales representatives and business partners, and following up on requests in a timely, courteous and professional manner. Maintaining a positive attitude and a helpful approach to customers and clients.Entering orders, change orders, tracking shipments, and entering customer notes to complete customer/consumer transactions. To include maintaining logs and records as required.Processing 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 include:Assisting with benefit verifications and prior authorizationsEntering orders, change orders, and entering customer notes to complete customer/consumer transactions. To include maintaining logs and records as required.Acting as the primary point of contact for healthcare providers to obtain complete patient enrollment and insurance informationLearning, understanding and following all company and client policies and procedures.Focusing on results in a professional, ethical, and responsible manner when dealing with customers, vendors, team members, and others.Accepting being accountable and responsible in work practices and expectations. Delivers what is promised.Fostering a collaborative, team-oriented attitude. Communicating effectively with others with clarity and transparency.Using innovative critical and creative thinking to evaluate and solve work and customer issues.Seeking assistance in solving work problems through collaboration and information seeking.Maintaining 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.Minimum knowledge, skills and abilities include:High School Diploma and 4 years' experience or Associate's Degree and 2 years' experience in healthcare settingExcellent 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.Preferred qualifications include:Customer service and/or call center experiencePatient assistance, reimbursement and/or pharmacy benefit management experienceMedical billing and coding experience

Job Description

Program Specialist IIThe 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.Essential duties and responsibilities include delivering excellent business results through the efforts of their teams by:Providing dedicated, personalized support delivered over the phone and via online portal.Completing investigations and answering questions regarding insurance benefits, including information about coverage and out-of-pocket costs. Collaborating with patients and doctors to assist with issues related to payments, reimbursements, payment denials, and appeals. Making outbound calls to customers for additional information.Assisting with prior authorization and medical necessity processes, benefit verification and prior authorization assistance.Administering comprehensive searches for alternate reimbursement resources, such as state and federal assistance programs, and enrollment assistance for qualified patients.Responding to inquiries from customers, sales representatives and business partners, and following up on requests in a timely, courteous and professional manner. Maintaining a positive attitude and a helpful approach to customers and clients.Entering orders, change orders, tracking shipments, and entering customer notes to complete customer/consumer transactions. To include maintaining logs and records as required.Processing 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 include:Assisting with benefit verifications and prior authorizationsEntering orders, change orders, and entering customer notes to complete customer/consumer transactions. To include maintaining logs and records as required.Acting as the primary point of contact for healthcare providers to obtain complete patient enrollment and insurance informationLearning, understanding and following all company and client policies and procedures.Focusing on results in a professional, ethical, and responsible manner when dealing with customers, vendors, team members, and others.Accepting being accountable and responsible in work practices and expectations. Delivers what is promised.Fostering a collaborative, team-oriented attitude. Communicating effectively with others with clarity and transparency.Using innovative critical and creative thinking to evaluate and solve work and customer issues.Seeking assistance in solving work problems through collaboration and information seeking.Maintaining 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.Minimum knowledge, skills and abilities include:High School Diploma and 4 years' experience or Associate's Degree and 2 years' experience in healthcare settingExcellent 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.Preferred qualifications include:Customer service and/or call center experiencePatient assistance, reimbursement and/or pharmacy benefit management experienceMedical billing and coding experience