Eligibility Representative

This is a fully remote position, open to applicants in Alabama, +2 more states.

📋 Description

• Assess and interpret insurance eligibility, coverage specifics, and benefit restrictions to ascertain clearance requirements.

• Initiate proactive communication with insurance providers and third-party payers to gather benefit information, address coverage inquiries, and verify authorization necessities.

• Navigate the prior authorization processes by collecting necessary information and ensuring compliance with payer criteria accurately.

• Thoroughly and consistently document benefit findings, authorization results, and clearance decisions within internal systems.

• Utilize feedback and payer expertise to enhance accuracy, efficiency, and overall quality of clearance processes.

• Assist specialty pharmacy patients in coordinating their medication needs and insurance coverage for complex medical conditions.

⛳️ Requirements

• At least 1 year of experience in a healthcare or health insurance environment performing eligibility verification, benefits investigation, prior authorizations, or patient access support.

• Direct experience interacting with insurance plans or payers, including making outbound calls to obtain or clarify coverage details.

• Working knowledge of pharmacy (PBM) benefits and medical benefits, with the ability to accurately interpret plan information.

• Proven experience in documenting insurance and authorization details with a high degree of accuracy and attention to detail.

• Ability to manage intricate, repetitive tasks in a structured setting while ensuring consistency and quality.

• Strong written and verbal communication skills for professional engagement with payer representatives.

• High School Diploma or equivalent.

• Must reside and work remotely in Alabama, Indiana, South Carolina, or Tennessee.

• Internet connection must be provided through a cable broadband or fiber optic service provider.

• Internet speeds must be at least 10Mbps for download and 5Mbps for upload.

🏝️ Benefits

• Remote work / work from home.

• Requirement for cable broadband or fiber optic internet service with speeds of at least 10Mbps download and 5Mbps upload.