Eligibility Representative, Specialty

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

📋 Description

• Verify patient insurance coverage, estimate costs, and document information in patient profiles.

• Accurately enter and update patient demographics in the system.

• Generate quotes for coverage and financial responsibilities.

• Discuss benefits with patients over the phone.

• Track, monitor, and secure necessary insurance and reimbursement documents.

• Obtain prior authorizations as required.

• Coordinate financial assistance forms, payment agreements, and waivers.

• Assist in training new employees during the onboarding process.

• Organize and prioritize daily tasks to achieve productivity and quality standards.

• Create new hospital and physician codes as necessary.

• Collaborate with internal teams to enhance reimbursement workflows and client service.

• Investigate reimbursement issues and contribute to ongoing improvement initiatives.

⛳️ Requirements

• High school diploma or GED equivalent.

• Minimum of 1 year of experience in insurance verification, prior authorization, or a related role within a healthcare environment.

• Familiarity with medical terminology.

• Proficient in computer skills, including Microsoft Office.

• Strong mathematical, communication, and organizational abilities.

• Experience with payer websites and coordination of benefits is preferred.

• Knowledge of pharmacy vs. medical payers and authorization processes is preferred.

• Understanding of plan formularies and authorization requirements is preferred.

• Availability to work Monday through Friday from 8:30 AM to 5:00 PM EST.

• For remote work, cable broadband or fiber optic internet service with a minimum speed of 10Mbps download and 5Mbps upload is required.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical insurance coverage.

• Vision insurance options.

• Dental insurance plans.

• Access to well-being and behavioral health programs.

• Participation in a 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement opportunities.

• At least 18 days of paid time off annually.

• Paid holidays provided.

• Leaves of absence available.

• Requirement for home workers to have cable broadband or fiber optic internet service with minimum speeds of 10Mbps download and 5Mbps upload.