Eligibility Senior Representative - Accredo

Cigna in; Philadelphia (Philadelphia County); Remote; USD 45,000 - 60,000; Full time

Job summary

A leading healthcare company seeks an Eligibility Senior Representative to perform specialized patient access functions. This role requires advanced knowledge of insurance benefits and involves collaboration with various stakeholders to ensure efficient referral processing. The candidate will also tackle drug coverage issues and enhance the patient experience through effective communication and problem-solving skills.

Qualifications

• 2-3 years of related working experience in healthcare.
• Intermediate data entry skills.
• Ability to handle professionally challenging customers.

Responsibilities

• Facilitate resolution of drug coverage issues.
• Independently resolve basic patient claims issues.
• Prepare and review claims for accuracy.

Skills

Communication

Problem Solving

Data Entry

Education

High school diploma or GED

Bachelor's degree

Tools

Microsoft Office

Job description

Eligibility Senior Representative - Accredo (Finance)

Job Description:

The Eligibility Senior Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes 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 and facilitate the timely processing of referrals. This individual can proactively recognize cause and effect trends, identify and clarify patients' needs, and work towards solutions.

ESSENTIAL FUNCTIONS:

1. Facilitate cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time.
2. Independently resolve basic patient claims issues using key subject matter knowledge.
3. Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations.
4. Effectively collaborate with internal departments to resolve issues or provide any needed information, always using professional communication.
5. Contact benefit providers to gather policy benefits/limitations.
6. Perform medical/pharmacy benefits verification requiring complex decision skills based on payer and process knowledge.
7. Complete other projects and additional duties as assigned.

JOB QUALIFICATIONS:

• High school diploma or GED required, bachelor's degree preferred.
• At least 2-3 years of related working experience.
• Must have healthcare experience with medical insurance knowledge and terminology and experience in patient access.
• Intermediate data entry skills and working knowledge of Microsoft Office.
• Excellent phone presentation and communication skills.
• Demonstrated ability to handle professionally challenging customers.
• 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.

ABOUT THE DEPARTMENT:

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. We also provide comprehensive management services—including outcomes measurement, counseling, clinical care management programs, social services, and reimbursement services. In these high-touch roles, employees have a daily opportunity to make a positive impact on their patients' lives.

NOTE: This is a work-at-home position, requiring reliable internet connectivity via a wired connection. A mobile or hotspot environment is not acceptable. You may need to purchase an Ethernet cord depending on your current setup.

If working from home occasionally or permanently, the internet connection must be through a cable broadband or fiber optic provider with speeds of at least 10 Mbps download and 5 Mbps upload.

About Evernorth Health Services:

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care, and benefit solutions to improve health and vitality. We innovate to make the prediction, prevention, and treatment of illness more accessible to millions. 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, or any other characteristic protected by law.

If you require reasonable accommodation to complete the online application, please email: [e-mail]. Do not email this address for application updates or resumes.

The Cigna Group maintains a tobacco-free policy and may not hire tobacco/nicotine users in certain states unless they participate in a qualifying smoking cessation program prior to 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.

Qualified applicants with criminal histories will be considered in accordance with all applicable laws.