Eligibility Specialist

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

📋 Description

• Deliver top-notch customer service to patients and client representatives.

• Gain comprehensive knowledge of client and marketing requirements.

• Execute benefit and eligibility verification for referrals from patients, medical offices, health plans, and pharmaceutical manufacturers.

• Research benefits and eligibility via phone and/or internet to establish patients’ coverage options for initiating therapy.

• Assess incoming referrals for completeness and verify compliance with FDA requirements as applicable.

• Respond promptly to incoming calls, evaluate needs, and either address or direct calls to the relevant team member.

• Assist with reimbursement inquiries, including insurance benefit verification, prior authorizations, denials, appeals, and other reimbursement matters.

• May offer billing and coding information specific to certain products.

• Conduct general research on payers.

• Engage in call center activities and triage incoming calls from patients, insurers, physicians, sales representatives, pharmacies, and homecare agencies.

• May act as the primary contact for a designated group of prescribers.

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

• Maintain precise and thorough documentation of inquiries.

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

• Comply with housekeeping, quality, production, safety, and environmental protocols and procedures.

• Perform additional duties as assigned.

⛳️ Requirements

• High School diploma or its equivalent.

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

• Prior experience in the PBM or Healthcare Industry is preferred.

• Proficiency in MS Office applications; experience with databases is advantageous.

• 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 manage multiple priorities and meet deadlines.

• Exceptional written and verbal communication skills, with a proven ability to interact effectively with individuals at all levels.

• Strong customer service skills—patience in explaining details and processes repeatedly, with excellent phone presentation skills.

• Proven ability to handle difficult 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 resolve complex issues with innovative solutions.

• Willingness to work a flexible schedule.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company match.*

• Tuition reimbursement programs.

• Flexible work environment.

• 20 days of paid time off, accrued.

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

• Health Savings Account/Flexible Spending Account options.

• Telemedicine services (virtual doctor appointments).

• Wellness initiatives.

• Adoption assistance programs.

• Short-term disability coverage.

• Long-term disability insurance.

• Life insurance options.

• Various discount programs.