Senior Eligibility Representative - Accredo - Remote

Cigna Healthcare

4d • $19 - $29 • Remote

About The Position

Delivers advanced administrative and business services in Eligibility as part of a dedicated Cystic Fibrosis team. Implements and maintains eligibility for benefits, including automated, direct connect, and manual data. Interacts with internal partners and external clients/vendors. Generates reports to identify and resolve discrepancies and identifies process improvement opportunities. May negotiate and resolve eligibility issues with clients and provide technical support for electronic processing. Ensures customer data is installed accurately and timely. May work with client formats and internal Systems to resolve errors and technical issues. Demonstrates advanced knowledge of manual and automated eligibility, reporting tools, and systems. Issues may be complex and require independent judgment. Works under defined procedures with minimal supervision. Cross-training in multiple systems and business areas of Patient Access is required, enabling team members to support various functions and ensure continuity of care for patients with complex needs.

Requirements

• High school diploma or GED
• 2 plus years of relevant working experience required
• Experience with health care, medical insurance terminology and patient access preferred
• Strong data entry skills and computer skills
• Excellent phone presentation and communication skills
• Demonstrated ability to handle difficult conversations in a professional manner
• Ability to adapt in a dynamic work environment and make decisions independently
• Advanced problem-solving skills and the ability to work collaboratively with other departments
• NOTE: We are currently training in a work at home environment, and you will be required to have reliable internet connectivity provided through a wired connection. A mobile or hot spot environment is not acceptable, and you may need to purchase an Ethernet cord depending on your current set up. 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.

Responsibilities

• Facilitates 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
• 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.)
• Perform medical/pharmacy benefit verification requiring complex decision skills based on payer and process knowledge

Benefits

• 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
• 401(k)
• company paid life insurance
• tuition reimbursement
• a minimum of 18 days of paid time off per year and paid holidays

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees