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 understanding of client and marketing needs.

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

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

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

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

• Provide assistance with reimbursement inquiries, which includes insurance benefit verification, prior authorizations, denials, appeals, and other reimbursement matters.

• Supply billing and coding information related to specific products as necessary.

• Conduct general research on payers.

• Engage in call center activities and triage incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies, and home care agencies.

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

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

• Maintain precise and complete documentation of inquiries.

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

• Follow housekeeping techniques, quality and production standards, as well as relevant safety and environmental procedures.

• Perform additional duties as assigned.

⛳️ Requirements

• High School diploma or equivalent.

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

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

• Proficiency in MS Office applications, with experience in databases 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.

• Capable of managing multiple priorities and meeting deadlines.

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

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

• Proven ability to manage challenging customers professionally and adapt in a fast-paced work environment, making decisions with minimal supervision.

• Advanced problem-solving capabilities and the ability to collaborate with other departments to resolve complex issues with innovative solutions.

• Flexibility to work a varied schedule.

🏝️ Benefits

• Remote work opportunities.

• Competitive salaries.

• Opportunities for career advancement.

• 401K plan with company matching.*

• Tuition reimbursement.

• Flexible work environment.

• 20 days of accrued PTO.

• Paid holidays.

• Employee assistance programs.

• Medical, dental, and vision coverage.

• HSA/FSA options.

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term and long-term disability coverage.

• Life insurance.

• Discount programs.