Eligibility Representative - Accredo-Remote

The job profile for this position is Eligibility Representative, which is a Band 1 Professional Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success.

Job Description

Summary Join a team that’s transforming health care to make it more affordable, predictable, and simple. As an Eligibility Representative, you’ll play a key role in supporting our customers by ensuring accurate and timely eligibility for benefits. Implements, updates, and maintains automated, direct connect and/or manual eligibility data. Interacts with internal partners and/or external clients/vendors. Generates reports to identify and resolve discrepancies. Identifies process improvement opportunities for own cases. May negotiate and resolve eligibility with clients. May provide technical support for the electronic processing of eligibility. Ensures customer data is installed accurately and timely. May work with client's format and internal Systems to resolve errors. May interact with Systems to resolve technical issues. General knowledge of manual and automated eligibility. Familiar with reporting tools. Technical understanding of systems. Issues tend to be routine in nature. Good knowledge and understanding of Eligibility and business/operating processes and procedures. Works to clearly defined procedures under close supervision. PRIMARY RESPONSIBILITIES:

• Performs medical/pharmacy benefit verification by contacting insurance companies or using provider portals for drug coverage and benefits.
• Facilitates cross-functional resolution of drug coverage issues and will proactively address, research & resolve issues resulting in timely onboarding of specialty patients.
• Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
• Perform insurance review on day of shipment to ensure insurance criteria is met for reimbursement and reduce the risk of bad debt.
• Effectively collaborates with internal departments to resolve issues or provide any needed information always using professional communication.
• Use discretion and independent judgement in handling patient or more complex client complaints and escalating to leadership as appropriate.
• Completes other projects and additional duties as assigned.

QUALIFICATIONS:

• High school diploma or GED required.
• 2-3 years of relevant working experience.
• Health care or professional office experience with medical insurance knowledge and terminology and experience in patient access preferred.
• Pharmacy/Specialty pharmacy experience a plus
• Proficient in Microsoft Office Products- Word, Outlook, Excel
• Excellent communication skills, including written, and oral phone presentation.
• Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
• Problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.

Training Schedule: Monday through Friday 8:00am-5:00pm Central Standard Time. The training will be for approximately the first 6-8 weeks of employment. Post-training schedule: This will be an eight-hour shift between the hours of 7:00am-7:00pm CST, Monday through Friday. The exact hours will be determined and presented to you during the offer stage. 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. 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. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances. Apply tot his job Apply To this Job