Eligibility Senior Representative - Accredo - Remote

Accredo Health Group • Greeneville, TN

240d • Hybrid

About The Position

Accredo is currently seeking an Eligibility Senior Representative. 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 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.

Requirements

• High school diploma or GED required.
• Health care experience with medical insurance knowledge and terminology and experience in patient access required.
• Medical or pharmacy billing strongly preferred.
• Intermediate data entry skills and working knowledge of Microsoft Office.
• 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.

Responsibilities

• Facilitate cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization.
• Perform medical/pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in onboarding or no starting a specialty patients.
• Contact benefit providers to gather policy benefits/limitations.
• Coordinate and ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
• Directly interface with external clients.
• Provide expert assistance to clients on patient status.
• Act as liaison for company providing referral status reporting.
• Handle escalations.
• Use discretion & independent judgement in handling patient or more complex client complaints, escalating as appropriate.
• Complete other projects and additional duties as assigned.

Benefits

• Opportunity to make a positive impact on patients' lives.
• Comprehensive management services including outcomes measurement, counseling, clinical care management programs, social services and reimbursement services.

What This Job Offers

• Career Level: Entry Level
• Industry: Merchant Wholesalers, Durable Goods
• Education Level: High school or GED