Eligibility Senior Representative - Accredo - Remote

The Reauthorization Senior Eligibility Representative plays an important role in helping patients maintain access to advanced therapy services. This role supports timely reauthorization renewals by reviewing payer requirements, gathering needed documentation, and partnering with provider offices, payers, and internal teams to help prevent therapy interruptions. The ideal candidate is detail-oriented, collaborative, and comfortable using their experience to resolve complex authorization and coverage barriers with professionalism and care.

Responsibilities

• Facilitate timely processing of reauthorization renewals to support continuity of care for patients receiving advanced therapy services.
• Review authorization requirements, clinical documentation, coverage criteria, and renewal deadlines to support payer compliance and accurate submissions.
• Partner with provider offices to obtain required clinical documentation and help ensure renewal requests are submitted on time.
• Coordinate with payers, provider offices, and internal stakeholders to support successful authorization renewals and continued reimbursement.
• Identify at-risk reauthorizations and proactively work with internal and external partners to help prevent therapy interruptions.
• Research and resolve coverage, benefit, authorization, and documentation barriers that may impact reauthorization turnaround times.
• Provide clear updates and guidance to internal and external clients regarding reauthorization renewal status, requirements, and next steps.
• Use sound judgment to manage complex patient access concerns, authorization issues, and escalations, involving leadership when appropriate.
• Support process improvement efforts, special projects, and other responsibilities as assigned.

Required Qualifications

• High school diploma or GED required.
• At least 3 years of relevant experience in healthcare, insurance, revenue cycle management, pharmacy operations, patient access, or a related field.
• Working knowledge of medical insurance, prior authorization processes, payer requirements, or patient access workflows.
• Intermediate data entry skills and working knowledge of Microsoft Office applications.
• Strong verbal and written communication skills with the ability to communicate clearly and professionally with payers, provider offices, patients, and internal teams.
• Ability to prioritize multiple reauthorization renewals, manage deadlines, and maintain a high level of accuracy.
• Strong problem-solving skills with the ability to work independently and collaborate across departments.

Preferred Qualifications

• Bachelor's degree preferred.
• Experience in specialty pharmacy, advanced therapy services, or patient access operations.
• Experience reviewing clinical documentation, coverage criteria, benefit limitations, authorization status, and effective dates.
• Ability to recognize trends, identify root causes, and recommend solutions that improve patient access and renewal outcomes.
• Demonstrated ability to handle challenging situations and customer interactions with empathy, professionalism, and good judgment.

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.

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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.