Eligibility Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate the existing real-time eligibility configurations, errors, workflows, active tickets, and high-volume payers.

• Create a prioritized roadmap based on factors such as volume, impact, urgency, and patient experience.

• Analyze payer/plan structures, plan mappings, unique plan mappings, synonyms, and ongoing maintenance requirements.

• Examine generic coverage utilization and address gaps in payer/plan configurations, workflows, and education.

• Assess HB and PB priority payers by 271 section, plan mapping, and benefit filing behaviors.

• Investigate deductibles, copays, Tier 1/Tier 2 benefits, service type mappings, and estimate accuracy issues.

• Enhance RTE coverage auto-creation processes and Medicare replacement chaining.

• Review coverage modifications, filing order, COB, and payer selection workflows.

• Collaborate with Patient Access to provide guidance on payer selection, registration education, job aids, and standardized workflows.

• Implement monitoring, documentation, ownership, and knowledge transfer to ensure internal team sustainability.

⛳️ Requirements

• RTE Certification is mandatory.

• Previous experience in active RTE roles is essential.

• Cadence or Prelude certification is advantageous.

• Tapestry integration experience is beneficial, but not obligatory.

• Must be legally authorized to work in the United States.

🏝️ Benefits

• Remote work options are available.

• Commitment to equal opportunity employment.

• Emphasis on a diverse workforce and an inclusive workplace.