Eligibility Senior Representative - Accredo- Remote

Cigna-posted about 1 year ago
Full-time
Hybrid
Insurance Carriers and Related Activities
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The Eligibility Senior Representative at Accredo plays a vital role in ensuring patient access to medications by performing eligibility functions that require a deep understanding of insurance benefits and internal processes. This position involves liaising with various stakeholders, including payers, pharmaceutical companies, physicians, and patients, to facilitate the authorization of medication payments.

  • Deliver straightforward administrative and/or other basic business services in Eligibility.
  • Implement and maintain eligibility for benefits.
  • Ensure customer data is input accurately and timely.
  • Contact benefit providers to gather policy benefits/limitations to ensure re-authorization of prescription medications.
  • Coordinate and ensure services provided will be reimbursable, including deductible amounts, co-payments, effective date, levels of care, and authorization.
  • Perform 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 of department policies and procedures.
  • Use discretion and independent judgment in handling patient or more complex client complaints, escalating as appropriate and triaging as needed.
  • High school diploma or GED required.
  • 1+ years of experience with medical insurance eligibility and prior authorization strongly preferred.
  • 2+ years of healthcare experience, medical terminology, and experience in patient access, strongly preferred.
  • Intermediate data entry skills with Microsoft Office; Outlook and Excel, required.
  • Knowledge of ESI/Accredo products and services, strongly preferred.
  • Professional phone presentation and communication skills, required.
  • 2+ years of experience handling challenging situations in a professional manner, required.
  • 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.
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