Program Specialist

Description:

The Program Specialist is responsible for serving as the customer’s primary point of contact providing operational and reimbursement support to complex programs within the company, including, but not limited to, marketing support, reimbursement hotlines, patient assistance programs, Hubs, foundations, safety surveillance programs, case management, and compliance programs. The focus of the Program Specialist is to own issues and remove obstacles that prevent patients or providers from accessing the therapies requested. The Program Specialist will be a self-starter who is comfortable taking initiative, identifying barriers, and working with the appropriate parties to eliminate these obstructions for the customer. The Program Specialist is proficient and knowledgeable about all the services provided on an assigned program and may support multiple client products or programs. The Program Specialist must be disciplined with the ability to speak with customers, sit and talk for long stretches.

Essential Job Duties:

* Quickly and efficiently respond to incoming calls and faxes, identify how best to assist.

* Document calls in appropriate tracking systems, and handle/escalate calls per established procedures.

* Conduct insurance verifications to understand if patient’s prescribed therapy is eligible for coverage. Possibly coordinate prior authorizations, investigate alternative insurance coverage, or other funding sources on behalf of the patients per the program specifications.

* Process patient applications of various complexities, and follow the programs specifications to determine their eligibility. Place follow up calls and respond to enquiries from patients and/or healthcare providers as necessary.

* Liaise with partner distributors and pharmaceutical manufacturers to request products per the program’s guidelines and track shipments.

* Coordinate the order and transfer of prescriptions based on their degrees of urgency to specialty pharmacies as appropriate.

* Be familiar with the market place and the insurance options available for patients. Educate patients on the available options as appropriate.

* Assist with training new team members by shadowing/reverse shadowing them and serving as a data checker by reviewing data entered in the program’s tracking system.

* Maintain a professional, calm and friendly demeanor. Express thoughts and instructions clearly in both verbal and written communication; i.e. uses grammatically correct and concise language.

* Other duties as assigned.

Skills:

healthcare industry, call center, customer care, medical, healthcare csr, health insurance, medical terminology, data entry, clerical