Eligibility Representative

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

📋 Description

• Confirm insurance benefits and navigate coverage requirements to assist patients in accessing medications.

• Offer support to patients, providers, and internal partners throughout the patient journey.

• Manage around 10–15 inbound calls daily concerning claims, account inquiries, insurance coverage, and medication shipment coordination.

• Execute an average of 25–35 outbound calls each day to insurance carriers, providers, patients, and internal partners.

• Investigate and resolve patient claims and coverage issues using established processes and expertise in the subject matter.

• Verify eligibility, benefits, coverage limitations, deductibles, copays, authorizations, and levels of care with insurance providers.

• Conduct medical and pharmacy benefit investigations utilizing payer-specific requirements and guidelines.

• Collaborate with cross-functional teams to address issues impacting referral turnaround times.

• Work together with internal departments to enhance patient access to therapy.

• Ensure services are reimbursable and documented accurately in accordance with payer requirements.

⛳️ Requirements

• Preferred experience with RxHome.

• Prior experience in healthcare, medical insurance, patient access, eligibility verification, benefits investigation, or a related field is preferred.

• Strong comprehension of healthcare and medical insurance terminology.

• Exceptional verbal and written communication abilities with a professional phone demeanor.

• Capability to manage challenging conversations with professionalism, empathy, and assurance.

• Keen attention to detail and strong organizational skills.

• Ability to multitask effectively in a fast-paced environment.

• Proficient in computer applications and data entry.

• High school diploma or equivalent is required.

• Reliable high-speed internet via a wired connection; hotspots and mobile internet are not acceptable.

• A private, distraction-free workspace is necessary while working remotely.

• Open availability Monday through Friday between 7:00 AM and 7:00 PM CST.

• Willingness to attend and successfully complete all mandatory training within the first 90 days of employment.

• Cable broadband or fiber optic internet service with a minimum of 10 Mbps download and 5 Mbps upload speed.

🏝️ Benefits

• Remote work arrangement.

• Approximately 8–12 weeks of classroom and on-the-job training.

• Full-time employment.