Eligibility Representative

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

📋 Description

• Develop and uphold comprehensive patient profiles by accurately inputting and updating demographic, prescription, insurance, prescriber, and pertinent clinical data in internal systems.

• Assess, confirm, classify, and direct incoming referrals and accompanying documents according to established intake workflows and case specifications.

• Analyze referral and prescription documentation utilizing knowledge of specialty medications, therapies, and treatment categories to ascertain subsequent steps and appropriate case routing.

• Investigate and resolve issues related to missing, incomplete, or inconsistent patient, prescriber, insurance, prescription, and clinical information to avoid processing delays.

• Engage and collaborate with patients, prescribers, clients, healthcare providers, insurance representatives, and internal teams to complete referrals, eliminate barriers, and facilitate timely access to therapy.

• Conduct quality checks and finalize necessary documentation, system updates, corrective measures, and task handoffs while adhering to Standard Operating Procedures, regulatory obligations, and privacy standards.

• Handle a high volume of referrals while achieving productivity, accuracy, quality, and turnaround-time goals.

⛳️ Requirements

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

• A minimum of 1 year of customer service experience.

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

• Proficient in managing detailed, repetitive tasks in a structured setting while ensuring consistency and quality.

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

• High School Diploma or equivalent.

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

• Internet access through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload while working from home.

• Strong attention to detail and data accuracy.

• Knowledge of medical, pharmacy, insurance, and specialty therapy terminology.

• Ability to interpret referrals, prescriptions, insurance, and clinical documentation.

• Strong organizational, research, and problem-solving skills.

• Capability to prioritize tasks and meet performance expectations.

• Dedication to quality, confidentiality, and compliance.

🏝️ Benefits

• Remote work arrangement.

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

• Tobacco-free policy; a qualifying smoking cessation program is available where applicable.