The Medical Benefit Liaison is responsible for working directly with provider offices to ensure a successful claim journey utilizing Mercalis’ medical benefit copay programs that need assistance for a variety of reasons including but not limited to: inquiries on how to submit a medical claim, troubleshooting issues, utilizing claims portal, investigating claim status, handling overrides/escalations or investigating/confirming payment receipt. The intention of this role is to be a growth and development role. You are part of the core team of one client and the intention is to collaborate within the team and be a team player. There is potential for growth within this team.

• Manages the day-to-day and end-to-end activities for multiple medical benefit copay programs as assigned
• Responsible for managing escalations and overrides for sites and pharmacies. For rejected claims, MBL's will be responsible for creating tasks and follow up to ensure claims are pulled through. For approved escalations, MBLs will work with internal teams to submit claims for re-processing
• Acting as main point of contact for all external stakeholders: sites, pharmacies, patients. Active and present on an inbound phone line as well as conducting regular outbound outreach
• Assists all stakeholders by acting as an advocate delivering detailed information for various medical claim situations
• Conduct outreach, verbal and written, to provider sites, patients and other stakeholders associated with supported programs to ensure turnaround times in line with client SLAs
• Provides unparalleled customer service while serving as a service representative – empathy for this particular program and therapeutic area is paramount. Team member must have recognized work history of demonstrating empathy
• Perform appropriate follow up tasks as needed to ensure successful claim journey
• Consistently exercises discretion to analyze, interpret, make conclusions and decide what actions to take for each situation
• Complete understanding of end-to-end medical claim processes to investigate scenarios and determine a resolution
• Become SME on HCP Navigator Portal, training sites on how to utilize, troubleshoot basic issues, escalate to appropriate internal resources, and manage registration approvals, utilizing a set of tools to conduct validation research.
• Support pharmaceutical reps with their sites as needed as it relates to their medical benefit program
• Maintains a high level of ethical conduct regarding confidentiality and privacy
• Maintains records in accordance with applicable standards and regulations to the programs/promotions
• Participates in program team meetings and improvement/enhancement initiatives both current and future
• Collaborates with external vendors and internal stakeholders as needed to properly document, escalate, and resolve issues
• Participates in continuing education activities to remain knowledgeable in all programs/promotions and other related areas
• Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events)
• Utilize Mercalis’ leadership competencies as the driving force behind the team’s success
• On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
• Ensure all SOPs are followed with consistency
• Conducts miscellaneous tasks or projects as assigned
• This position is expected to be local and on site during initial training and remote thereafter with occasional on site workdays

• Bachelor’s degree and 2-4 years of medical benefit reimbursement/insurance, healthcare billing, physician office, health insurance processing preferred or in lieu of a degree, a High School diploma or equivalent with 4-6 years of medical benefit reimbursement/insurance, healthcare billing, physician office, health insurance processing
• Strong understanding of medical claims processing, rejection troubleshooting, and provider medical claims workflows a plus
• Strong sense of empathy and understanding for patient journey, always seeking to be an advocate with patient-centric mentality
• Ability to provide exceptionally articulate verbal and written communication
• Proficient with Microsoft products including MS Excel skills with the ability to review data sets to conclude outcome
• Directly supporting and liaising between the client facing teams and technology & operational delivery teams
• Ability to manage and prioritize workload based on competing demands
• Customer Service – ability to collaborate with users to articulate requests, issues and resolution on time
• Proven problem-solving abilities and strong organizational skills to successfully manage various types of escalations
• Logical and efficient with attention to detail and committed follow through in communication with all stakeholders
• Willing to work in a dynamic, fast paced environment and have the ability to multi-task with multiple escalations
• Strong interpersonal skills, ability to work both independently and as part of a team
• Initiative and strong work ethic critical
• Ability to multitask and prioritize in a fast-paced environment
• Excellent problem-solving and decision-making skills required
• Attention to details
• Strong organizational skills
• All internal candidate with these qualifications are encouraged to apply
  

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