Program Specialist II Bilingual Only

EVERSANA; Mason (OH); On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a dedicated Program Specialist II to support Spanish-speaking patients and their healthcare providers. This role involves assisting with insurance benefits, reimbursements, and general inquiries, ensuring a smooth experience for patients. The ideal candidate will possess strong communication skills, a positive attitude, and the ability to thrive in a fast-paced environment. Join a company that values patient-centric care and fosters a collaborative atmosphere where your contributions can make a significant impact on patient outcomes.

Qualifications

• 4 years' experience in healthcare or 2 years with an Associate's Degree.
• Strong communication skills and ability to work in a fast-paced environment.

Responsibilities

• Provide personalized support for insurance benefits and reimbursements.
• Assist with prior authorizations and maintain customer records.

Skills

Communication Skills

Multi-tasking

Detail-oriented

Positive Attitude

Education

High School Diploma

Associate's Degree

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

Job Description

THE POSITION:

The Program Specialist II will provide dedicated support to Spanish speaking patients and their doctors for activities related to benefit coverage, payments, reimbursements, denials and general inquiry phone calls through our patient services support center when needed.

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, 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 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.

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.

Qualifications:

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES:

• 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.

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.