Eligibility Representative

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Validate insurance benefits and navigate coverage prerequisites to assist patients in obtaining medications.

• Manage around 10–15 incoming calls daily from patients and providers concerning claims, accounts, insurance coverage, and medication shipments.

• Conduct approximately 25–35 outgoing calls each day to insurance carriers, providers, patients, and internal stakeholders.

• Investigate and resolve patient claims and coverage issues utilizing established procedures and subject matter expertise.

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

• Execute medical and pharmacy benefit investigations in accordance with payer-specific criteria and guidelines.

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

• Collect and furnish information to facilitate patient access to therapy.

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

⛳️ Requirements

• Experience with RxHome is preferred.

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

• Strong comprehension of healthcare and medical insurance terminology.

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

• Capability to handle challenging conversations with professionalism, empathy, and confidence.

• Keen attention to detail and strong organizational skills.

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

• Proficient in computer applications and data entry.

• High school diploma or equivalent is required.

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

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

• 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

• Competitive salary.

• Comprehensive health benefits.

• Opportunities for professional development and growth.

• Flexible work schedule.

• Supportive work environment.