Eligibility Representative

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

📋 Description

• Evaluate and analyze insurance eligibility, coverage specifics, and benefit restrictions to establish clearance prerequisites.

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

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

• Thoroughly and consistently document benefit assessments, authorization results, and clearance determinations within internal systems.

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

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

• Address each inquiry with care, precision, and empathy.

⛳️ Requirements

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

• Direct experience collaborating with insurance plans or payers, including making outbound calls to secure or clarify coverage information.

• Proficient understanding of pharmacy (PBM) benefits and medical benefits, with the capability to accurately interpret plan specifics.

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

• Capability to handle detailed, repetitive tasks in a structured setting while maintaining consistency and quality.

• Exceptional written and verbal communication skills suitable for professional interactions with payer representatives.

• High School Diploma or equivalent.

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

• If working from home, internet must be sourced from a cable broadband or fiber optic provider with a minimum speed of 10Mbps download/5Mbps upload.

🏝️ Benefits

• Remote work arrangement.

• Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload required for home working.

• Reasonable accommodation assistance for the online application process.