[Hiring] Pharmacy Technician @EVERSANA

Role Description

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

• 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.
• 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.

Expectations of the Job

• Travel: 0%.
• 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.

Qualifications

• High School Diploma/GED.
• One to two years of relevant experience in healthcare operations, benefit verification, or a related customer service role.
• Accurate and detail-oriented.
• Experience supporting customers, patients, providers or administrative processes in a pharmacy or healthcare setting.
• Demonstrated data-entry and customer service capability.
• Experience conducting benefit investigations, insurance verification, documentation review, program support, patient access support, or similar healthcare operations activities.
• Working knowledge of medical and pharmacy benefit structures, payer types, and reimbursement processes.
• Ability to effectively manage high-volume phone interactions while maintaining quality and customer service standards.
• Advanced computer proficiency with strong data entry accuracy and productivity.
• Proficient in Microsoft Word, Excel, Outlook, and PowerPoint, including the ability to create reports and analyze routine data.
• Demonstrated experience utilizing patient support, case management, CRM, healthcare operations, and workflow management systems.
• Ability to efficiently navigate multiple databases, applications, and electronic systems simultaneously.
• Proficiency with telephony/call center technology and associated documentation tools.
• Ability to accurately maintain electronic patient records and resolve routine data discrepancies.
• Ability to troubleshoot basic system, workflow, and user issues within supported applications.
• Reliability, independent judgment, customer focus, critical thinking, issue resolution, prioritization, and clear communication.
• Strong oral, written, and interpersonal communication skills, with the ability to explain program requirements clearly to patients, providers, and payers.
• Ability to multi-task and solve moderately complex problems using independent judgment.
• Ability to work independently, have personal accountability, and function as a collaborative team player.
• Ability to work in a fast-paced, metric-driven environment while remaining patient-minded.
• Strong customer service skills. Adaptable, resilient, and aligned with EVERSANA's culture, values, and commitment to excellence.
• Ability to obtain a Missouri pharmacy technician registration (may not be required for all positions).

Preferred Qualifications

• Associate’s Degree.
• Experience in a pharmacy or healthcare setting.
• Customer service and/or call center experience.
• Medical billing experience.

Physical/Mental Demands and Working Environment

• 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.
• This job operates in a professional office and/or remote work environment.
• This role routinely uses standard office equipment.
• The noise level in the work environment is usually moderately quiet, with frequent interruptions and multiple demands.
• This role requires mental alertness. The employee must regularly communicate both verbally and in writing; concentrate on tasks; and remember and observe details.
• The employee must frequently adjust to changes; handle stress and emotions; and think analytically.

Additional Information

EVERSANA is committed to providing competitive salaries and benefits for all employees. If this job posting includes a base salary range, it represents the low and high end of the salary range for this position and is not applicable to locations outside of the U.S. Compensation will be determined based on relevant experience, other job-related qualifications/skills, and geographic location (to account for comparative cost of living).