Eligibility Representative - Accredo - Remote

Cigna in; Las Vegas (NV); Remote; Full time

Job summary

A leading healthcare company seeks an Eligibility Representative to manage patient access functions. This remote role requires expertise in insurance benefits and collaboration with various stakeholders to enhance patient experience. Responsibilities include resolving drug coverage issues, preparing claims, and ensuring services are reimbursable. The ideal candidate will have healthcare experience, strong communication skills, and problem-solving abilities. Enjoy a supportive culture with comprehensive benefits starting from day one.

Benefits

Medical, Dental, & Vision coverage from Day 1

18 days Paid Time Off & 8 Paid Holidays

Employer contributions to HRA & HSA

401K + Company Match

Tuition Assistance

Qualifications

• 1-2 years of healthcare experience with medical insurance knowledge.
• Experience training and coaching less experienced staff.

Responsibilities

• Facilitate resolution of drug coverage issues.
• Prepare and review claims for accuracy.
• Provide expert assistance to internal and external clients.

Skills

Communication

Problem-Solving

Adaptability

Education

High school diploma or GED

Bachelor's degree

Tools

Microsoft Office

Patient Access

Job description

Eligibility Representative - Accredo - Remote (Finance)

The Eligibility Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes to liaise effectively with Payers, Pharma, Physicians, and Patients. They rely on experience and knowledge of industry best practices to communicate about pending referrals that may impact company goals and the patient experience. Acting as a liaison between internal and external resources, they aim to reduce client abrasion and facilitate timely referral processing. They can proactively recognize trends, identify patient needs, and work towards solutions.

PRIMARY RESPONSIBILITIES:

1. Facilitate resolution of drug coverage issues and proactively address, research, and resolve issues impacting referral turnaround time.
2. Resolve basic patient claims issues independently using subject matter knowledge.
3. Prepare and review claims for accuracy according to payer requirements, including codes, dates, and authorizations.
4. Demonstrate technical proficiency in patient access functions.
5. Collaborate with internal departments to resolve issues or provide needed information using professional communication.
6. Contact benefit providers to gather policy benefits and limitations.
7. Coordinate and ensure services are reimbursable, including deductible amounts, co-payments, effective dates, levels of care, and authorizations.
8. Perform medical/pharmacy benefit verification requiring complex decision skills based on payer and process knowledge.
9. Provide expert assistance to internal and external clients regarding patient status.
10. Handle escalations with an understanding of department policies and procedures.
11. Use discretion and independent judgment in handling patient or complex client complaints, escalating as appropriate.
12. Complete other projects and duties as assigned.

Training is from 8:30 am - 5:30 pm EST, Monday - Friday, for 4 to 5 weeks. The permanent schedule will be 11 am - 8 pm EST, Monday through Friday.

QUALIFICATIONS:

• High school diploma or GED required; bachelor's degree preferred.
• 1-2 years of healthcare experience with medical insurance knowledge and terminology; patient access experience preferred.
• Intermediate data entry skills and working knowledge of Microsoft Office and Patient Access.
• Extensive knowledge of ESI products and services.
• Experience training and coaching less experienced staff with patience.
• Excellent phone presentation and communication skills.
• Ability to handle challenging customers professionally.
• Adaptability in a dynamic environment and decision-making with minimal supervision.
• Advanced problem-solving skills and collaborative work approach.

What you'll love about working here:

• Fun, friendly, and unique culture—bring your whole self to work!
• Medical, Dental, & Vision coverage from Day 1
• 18 days Paid Time Off & 8 Paid Holidays
• Employer contributions to HRA & HSA
• 401K + Company Match
• Tuition Assistance

Note: Reliable internet connectivity via wired Ethernet is required. Mobile or hotspot connections are not acceptable, and you may need to purchase an Ethernet cord.

About Accredo

Through our healthcare products and services, Accredo provides in-depth care for patients with chronic conditions like hemophilia, oncology, rheumatoid arthritis, and growth hormone deficiency. We offer comprehensive management services, including outcomes measurement, counseling, clinical care management, social services, and reimbursement services. Our high-touch roles allow employees to positively impact patients' lives daily.

For remote work, internet must be broadband or fiber optic with speeds of at least 10 Mbps download / 5 Mbps upload.

The anticipated hourly rate is $17.75 - $25 USD, depending on experience and location. The role may also be eligible for an annual bonus plan.

Benefits

We support your health and well-being with comprehensive benefits starting Day 1, including medical, vision, dental, well-being programs, 401(k) with match, life insurance, tuition reimbursement, paid time off, and holidays. More info at Life at Cigna Group.

About Evernorth Health Services

A division of The Cigna Group, Evernorth creates pharmacy, care, and benefit solutions to improve health and vitality through innovation for millions.

Qualified applicants will be considered regardless of race, color, age, disability, sex, pregnancy, sexual orientation, gender identity, veteran status, religion, national origin, or other protected characteristics.

For reasonable accommodation requests, email [e-mail]. Do not email for application updates or resumes.

The Cigna Group is tobacco-free and may not hire tobacco/nicotine users in certain states unless they participate in a cessation program. Consideration for criminal histories will comply with applicable laws.