Eligibility Senior Representative - Accredo

Accredo Specialty Pharmacy; Tennessee; Remote; USD 40,000 - 60,000; Full time

Job summary

Accredo Specialty Pharmacy seeks an Eligibility Senior Representative to facilitate patient access and collaborate with Payers, Pharma, Physicians, and Patients. This role requires an understanding of insurance benefits and resolving patient claims, with strong communication and problem-solving skills essential for navigating a dynamic work environment.

Qualifications

• At least 2-3 years of related experience in healthcare with medical insurance knowledge.
• Excellent phone presentation and communication skills required.
• Ability to make decisions with minimal supervision.

Responsibilities

• Facilitate resolution of drug coverage issues and improve referral turnaround time.
• Prepare and review claims for accuracy according to payer requirements.
• Liaise with benefit providers to gather policy benefits and limitations.

Skills

Data entry skills

Communication skills

Problem-solving skills

Ability to handle challenging customers

Education

High school diploma or GED

Bachelor’s degree (preferred)

Tools

Microsoft Office

Job description

Eligibility Senior Representative - Accredo

Join to apply for the Eligibility Senior Representative - Accredo role at Accredo Specialty Pharmacy.

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 information about pending referrals that may impact company goals and the patient experience. Acts as a liaison between internal and external resources to reduce client abrasion and facilitate the timely processing of referrals. This individual proactively recognizes cause and effect trends, identifies and clarifies patients’ needs, and works towards solutions.

Essential Functions

• Facilitate cross-functional resolution of drug coverage issues and proactively address, research, and resolve issues impacting referral turnaround time.
• Resolve basic patient claims issues independently using key subject matter knowledge.
• Prepare and review claims to ensure accuracy according to payer requirements, including codes, dates, and authorizations.
• Collaborate effectively with internal departments to resolve issues or provide needed information, maintaining professional communication.
• Contact benefit providers to gather policy benefits and limitations.
• Perform medical/pharmacy benefits verification requiring complex decision-making skills based on payer and process knowledge.
• 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 experience in healthcare 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.
• 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 ability to work collaboratively to resolve issues with innovative solutions.

Additional Information

This is a work-at-home position requiring reliable internet connectivity via a wired connection with at least 10Mbps download and 5Mbps upload speeds. Mobile or hotspot connections are not acceptable.

About Evernorth Health Services: A division of The Cigna Group providing pharmacy, care, and benefit solutions to improve health and vitality.

Qualified applicants will be considered regardless of race, color, age, disability, sex, or other protected characteristics. For accommodations, contact [e-mail].

The Cigna Group has a tobacco-free policy and considers applicants with criminal histories according to applicable laws.