Eligibility Senior Representative- Accredo- Remote
The Cigna GroupAbout the role
The Eligibility Senior 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. This role directly interfaces with external clients and requires a high level of independent judgment and a degree of forward planning and anticipation of needs/issues in order to establish and maintain effective relationships with clients to gain their trust and support. Relies on experience and knowledge of industry best practices to identify exposures to the company and facilitates leadership’s 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 and provide accurate status reporting to clients.
ESSENTIAL FUNCTIONS
Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization.
Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
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.).
Directly interfaces with external clients.
Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
Provide expert assistance to clients on patient status.
Liaison for company providing referral status reporting.
May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome.
Handle Escalations.
Use discretion & independent judgement in handling pt or more complex client complaints, escalating as appropriate.
Completes other projects and additional duties as assigned.
QUALIFICATIONS
High school diploma or GED required, bachelor’s degree preferred.
3-5 years of relevant experience.
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 communication skills. Including phone calls, written, and meeting presentation.
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.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Generate a tailored application kit with a matched cover letter, interview prep, and CV highlights — in under 60 seconds. Free account required — sign up in 30sApply for this role