Eligibility Representative

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

📋 Description

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

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

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

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

• Investigate and resolve patient claims and coverage challenges using established procedures and expertise.

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

• Execute thorough medical and pharmacy benefit investigations following payer-specific requirements and guidelines.

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

• Work with internal departments to collect and relay information that supports patient access to therapy.

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

⛳️ Requirements

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

• Experience with RxHome is preferred.

• Strong knowledge of healthcare and medical insurance terminology.

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

• Capacity to handle challenging conversations with professionalism, empathy, and assurance.

• Keen attention to detail and strong organizational skills.

• Ability to multitask in a fast-paced environment.

• Proficient in computer applications and data entry.

• High school diploma or equivalent is required.

• Access to reliable high-speed internet via a wired connection; hotspots and mobile internet are not allowed.

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

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

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

🏝️ Benefits

• Remote work option.

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

• Training schedule from Monday to Friday, 8:00 AM–5:00 PM CST.

• Required completion of training within the first 90 days of employment.

• Reliable high-speed wired internet for remote work.

• A private, distraction-free workspace.

• Tobacco-free policy.

• Reasonable accommodation assistance for the online application process.