Job Description
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.
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 on boarding 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.
- Perform medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
- 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.
QUALIFICATIONS: - 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.
ABOUT THE DEPARTMENT Through our range of health care products and services offered, Accredo team members provide in-depth care for patients with hemophilia, In addition to health care products, we provide comprehensive management services - including outcomes measurement, counseling, clinical care management programs, social services and reimbursement services. By performing in these very high-touch roles, employees have a daily opportunity to make a positive impact on their patients' lives.
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.
About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Job Tags
Permanent employment, Local area, Remote job,