Eligibility Representative, Specialty - Evernorth- Remote
About The Position
The job profile for this position is Eligibility Representative, which is a Band 1 Professional Career Track Role. Our people make all the difference in our success. As an Insurance Verification Coordinator, you will help patients access the care they need by ensuring accurate insurance verification, clear communication of benefits, and timely completion of reimbursement requirements. You will play a key role in creating a smooth, supportive experience for patients and providers. This role supports CarepathRx within our Pharmacy and Care Delivery organization. Our team focuses on specialty pharmacy and infusion services in partnership with hospitals and health systems.
Requirements
- High school diploma or GED.
- 1+ year of insurance verification, prior authorization, or related experience in a healthcare setting.
- Knowledge of medical terminology.
- Proficient computer skills, including Microsoft Office.
- Strong math, communication, and organizational skills.
Nice To Haves
- Experience with payer websites and coordination of benefits.
- Knowledge of pharmacy vs. medical payers and authorization processes.
- Familiarity with plan formularies and authorization requirements.
Responsibilities
- Verify patient insurance coverage, calculate estimated costs, and document details clearly in the patient profile.
- Enter and update accurate patient demographics in the system.
- Generate coverage and financial responsibility quotes and review benefits with patients by phone.
- Track, monitor, and secure required insurance and reimbursement documents.
- Obtain prior authorizations and coordinate financial assistance forms, payment agreements, and waivers.
- Support onboarding by helping train new employees.
- Organize and prioritize daily tasks to meet productivity and quality standards.
- Create new hospital and physician codes as needed.
- Partner with internal teams to ensure smooth reimbursement workflows and excellent client service.
- Research reimbursement issues and contribute to continuous improvement efforts.
Benefits
- medical
- vision
- dental
- well-being and behavioral health programs
- 401(k)
- company paid life insurance
- tuition reimbursement
- a minimum of 18 days of paid time off per year
- paid holidays
- leaves of absence
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
