Eligibility Representative - Accredo - Remote

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

PRIMARY RESPONSIBILITIES:

• Facilitates cross-functional resolution of drug coverage issues & proactively address, research & resolves issues impacting referral turn-around time.

• Independently resolves basic patient claims issues using key subject matter knowledge.

• Prepares and reviews claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations.

• Demonstrates a technical proficiency to patient access functions.

• Effectively collaborates with internal departments to resolve issues or provide any needed information using professional communication at all times.  

• Contacts benefit providers to gather policy benefits/limitations.

• Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).

• Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge.

• Provide expert assistance to internal and external clients on patient status.

• Handle Escalations with expert understanding on department policies and procedures.

• Use discretion & independent judgement in handling patient or more complex client complaints, escalating as appropriate and when to triage as needed.

• Completes other projects and additional duties as assigned.

Training is 8:30 am - 5:30 pm EST Monday - Friday for 4 to 5 weeks.

The permanent schedule for this role would be 11 am - 8 pm EST Monday through Friday.

QUALIFICATIONS:

• High school diploma or GED required; bachelor’s degree preferred.

• 1-2 years of Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.

• Intermediate data entry skills and working knowledge of Microsoft Office, Patient Access knowledge.

• Extensive knowledge of ESI products and services a must.

• Experience training and coaching less experienced staff with patience to explain details and processes repeatedly.

• Excellent phone presentation and communication skills.

• Demonstrated ability to handle challenging customers in a professional manner.

• 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.

What you’ll love about working here:

• Fun, friendly & unique culture – Bring your whole self to work every day!

• Medical Dental & Vision start on Day 1

• 18 days Paid Time Off & 8 Paid Holidays

• Employer Contributions for HRA & HSA accounts

• 401K + Company Match

• Tuition Assistance

NOTE: You will be required to have reliable internet connectivity provided through a wired (Ethernet) connection.  A mobile or hot spot environment is not acceptable, and you may need to purchase an Ethernet cord depending on your current setup. 

ABOUT ACCREDO
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. In addition to healthcare products, we provide comprehensive management services – including outcomes measurement, counseling, clinical care management programs, social services, and reimbursement services. By performing in these very high-touch roles, employees have a daily opportunity to positively impact their patients’ lives.