Eligibility Specialist

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

📋 Description

• Deliver exceptional customer service to patients and client representatives.

• Gain comprehensive knowledge of client needs and marketing objectives.

• Verify benefits and eligibility for referrals from patients, medical offices, health plans, and pharmaceutical manufacturers.

• Assess incoming referrals for completeness and ensure compliance with FDA requirements when necessary.

• Respond promptly and effectively to incoming calls, assessing needs and directing calls to the appropriate team member.

• Assist with inquiries related to reimbursement, including insurance benefit verification, prior authorization, denials, appeals, and other related issues.

• Provide billing and coding details for specific products as applicable.

• Conduct general payer research.

• Engage in call center operations, triaging calls from patients, insurance companies, physicians, sales representatives, pharmacies, and homecare agencies.

• Act as a primary contact for a designated group of prescribers when necessary.

• Oversee action item lists to ensure timely completion of tasks.

• Keep accurate and thorough documentation of inquiries.

• Recognize and escalate recurring questions or issues for corrective measures.

• Uphold good housekeeping practices while adhering to quality, production, safety, and environmental standards.

• Carry out additional duties as assigned.

⛳️ Requirements

• High School diploma or equivalent qualification.

• 3-5 years of experience in a customer service role, ideally within a call center.

• Previous experience in the Pharmacy Benefit Manager (PBM) or Healthcare Industry is preferred.

• Proficiency in MS Office applications, with experience in database management preferred.

• Experience in health insurance claims or patient accounting is preferred.

• Familiarity with third-party billing, coding, medical terminology, prior authorizations, and appeals is preferred.

• Detail-oriented with strong analytical skills.

• Capability to handle multiple priorities and meet deadlines.

• Outstanding written and verbal communication skills, with the ability to communicate effectively with all levels of personnel.

• Excellent customer service skills, including the patience to explain details and processes repeatedly, and strong phone presentation skills.

• Proven ability to manage challenging customers professionally, adapt in a dynamic work environment, and make decisions with minimal supervision.

• Advanced problem-solving abilities and the capacity to collaborate with other departments to address complex issues with innovative solutions.

• Flexibility to work varied schedules.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for professional development and promotion.

• 401K plan with company matching.

• Tuition reimbursement programs.

• Flexible work environment.

• Accrued 20 days of paid time off (PTO).

• Paid holidays.

• Employee assistance programs.

• Coverage for medical, dental, and vision.

• Health Savings Account (HSA) and Flexible Spending Account (FSA).

• Access to telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Employee discount programs.