Eligibility Representative - Remote

About the position As an Eligibility Representative, you will be part of a team passionate about helping our patients with billing and ensuring their access to life saving medications.

Responsibilities

• Deliver straightforward administrative and/or other basic business services in Eligibility
• Implement and maintain eligibility for benefits
• Implement, update, and maintain automated, direct connect and/or manual eligibility data
• Interact with internal partners and/or external clients/vendors
• Generate reports to identify and resolve discrepancies
• Identify process improvement opportunities for own cases
• Negotiate and resolve eligibility with clients
• Facilitate cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time
• Independently resolve basic patient claims issues using key subject matter knowledge
• Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates and authorizations
• Effectively collaborate with internal departments to resolve issues or provide any needed information
• Contact benefit providers to gather policy benefits/limitations
• Coordinate and ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
• Perform medical/pharmacy benefit verification requiring complex decision skills based on payer and process knowledge
• Provide technical support for the electronic processing of eligibility
• Ensure customer data is installed accurately and timely
• Work with client's format and internal systems to resolve errors
• Interact with systems to resolve technical issues

Requirements

• Must be able to work an 8 hour shift within the hours of 7am - 6pm EST (Mon - Fri)
• High School diploma or GED required
• 1+ years of relevant working experience - customer service, billing, healthcare, pharmacy, insurance industry preferred
• Experience with healthcare, medical insurance terminology and patient access preferred
• General knowledge & understanding of manual and automated eligibility
• General PC knowledge including experience working with Microsoft Office, Excel, Teams, SharePoint, PowerPoint
• Strong data entry skills and computer skills
• Excellent phone presentation and communication skills
• Demonstrated ability to handle difficult conversations in a professional manner
• Ability to adapt in a dynamic work environment and make decisions independently
• Advanced problem solving skills and the ability to work collaboratively with other departments
• Works to clearly defined procedures under close supervision
• The internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Nice-to-haves

• Familiar with reporting tools and/or RX Home, Copay Assistance, or CSP experience a plus

Benefits

• medical
• vision
• dental
• well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• a minimum of 18 days of paid time off per year
• paid holidays
• leaves of absence