Eligibility Representative

This is a fully remote position, open to applicants in Arizona, +1 more state.

📋 Description

• Develop and sustain comprehensive patient profiles, encompassing demographic, prescription, insurance, prescriber, and clinical details.

• Assess, verify, categorize, and direct incoming referrals along with their supporting documents.

• Analyze referral and prescription materials to identify subsequent actions and appropriate case routing.

• Investigate and rectify any missing, incomplete, or inconsistent information regarding patients, prescribers, insurance, prescriptions, and clinical data.

• Engage and collaborate with patients, prescribers, clients, healthcare providers, insurance representatives, and internal stakeholders.

• Conduct quality assurance checks and finalize documentation, system updates, corrective measures, and task transitions.

• Adhere to standard operating procedures, regulatory standards, and privacy regulations.

• Handle a significant volume of referrals while achieving productivity, accuracy, quality, and turnaround time expectations.

⛳️ Requirements

• At least 1 year of experience in a healthcare or health insurance environment.

• A minimum of 1 year of experience in customer service.

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

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

• Excellent written and verbal communication skills suitable for professional engagements with payer representatives.

• High School Diploma or equivalent qualification.

• Must reside and work remotely in South Carolina or Arizona.

• Strong attention to detail and commitment to data accuracy.

• Familiarity with medical, pharmacy, insurance, and specialty therapy terminology.

• Ability to interpret referrals, prescriptions, insurance documents, and clinical paperwork.

• Dedication to quality, confidentiality, and compliance standards.

• Reliable internet connection through cable broadband or fiber optic service, with a minimum of 10Mbps download and 5Mbps upload speed for remote work.

🏝️ Benefits

• Opportunity for remote work.

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

• Adherence to a tobacco-free policy.

• Support for reasonable accommodations during the online application process.