Eligibility Senior Representative - Accredo - Work From Home

The Eligibility Senior Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes in order to successfully liaise with Payers, Pharma, Physicians, and Patients. Relies on experience and knowledge of industry best practices to communicate knowledge of pending referrals that may have an adverse impact on company goals and the patient experience. Acts as a liaison between both internal and external resources to reduce client abrasion, facilitate the timely processing of referrals. This individual can proactively recognize cause and effect trends, identify and clarify patients’ needs, and work towards solutions.
PRIMARY RESPONSIBILITIES:
Facilitates cross-functional resolution of drug coverage issues & proactively address, research & resolves issues impacting referral turn-around time.
Independently resolves basic patient claims issues using key subject matter knowledge.
Prepares and reviews claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations.
Demonstrates a technical proficiency to patient access functions.
Effectively collaborates with internal departments to resolve issues or provide any needed information using professional communication at all times.
Contacts benefit providers to gather policy benefits/limitations.
Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge.
Provide expert assistance to internal and external clients on patient status.
Handle Escalations with expert understanding on department policies and procedures.
Use discretion & independent judgement in handling patient or more complex client complaints, escalating as appropriate and when to triage as needed.
Completes other projects and additional duties as assigned.
QUALIFICATIONS:
High school diploma or GED required, bachelor’s degree preferred.
3-5 years of relevant working experience.
Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.
Intermediate data entry skills and working knowledge of Microsoft Office, Patient Access knowledge.
Extensive knowledge of ESI products and services a must.
Experience training and coaching less experienced staff with patience to explain details and processes repeatedly.
Excellent phone presentation and communication skills.
Demonstrated ability to handle challenging customers in a professional manner.
Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.
What you’ll love about working here:
Fun, friendly & unique culture – Bring your whole self to work every day!
Medical Dental & Vision start on Day 1
18 days Paid Time Off & 8 Paid Holidays
Employer Contributions for HRA & HSA accounts
401K + Company Match
Tuition Assistance
NOTE: You will be required to have reliable internet connectivity provided through a wired (Ethernet) connection. A mobile or hot spot environment is not acceptable, and you may need to purchase an Ethernet cord depending on your current setup.
ABOUT ACCREDO
Through our range of healthcare products and services offered, Accredo team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis, and growth hormone deficiency. In addition to healthcare products, we provide comprehensive management services – including outcomes measurement, counseling, clinical care management programs, social services, and reimbursement services. By performing in these very high-touch roles, employees have a daily opportunity to positively impact their patients’ lives.
If you will be working at home occasionally or permanently, 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.
For this position, we anticipate offering an hourly rate of 17 - 25 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.