Eligibility Senior Representative - Accredo - Remote

Cigna Healthcare

1d • $19 - $29 • Remote

About The Position

The Eligibility Senior Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes 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 and facilitate the timely processing of referrals. This individual can proactively recognize cause and effect trends, identify and clarify patients’ needs, and work towards solutions. Hours/Schedule: Monday- Friday, 9am-5:30pm EST

Requirements

• High school diploma or GED required.
• At least 2+ years of related working experience.
• Must have healthcare experience with medical insurance knowledge and terminology and experience in patient access.
• Intermediate data entry skills and working knowledge of Microsoft Office.
• Excellent phone presentation and communication skills.
• Demonstrated ability to handle professionally challenging customers.
• 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.
• If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Nice To Haves

• RxHome experience preferred.

Responsibilities

• Facilitate cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time.
• Independently resolve basic patient claims issues using key subject matter knowledge.
• Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations.
• Effectively collaborate with internal departments to resolve issues or provide any needed information, always using professional communication.
• Effectively collaborate with internal departments to resolve issues or provide any needed information, always using professional communication.
• Contact benefit providers to gather policy benefits/limitations.
• Perform medical /pharmacy benefits verification requiring complex decision skills based on payer and process knowledge.
• Complete other projects and additional duties as assigned.

Benefits

• 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), 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, click here.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED