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.

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

• Assess incoming referrals for completeness and ensure FDA requirements are met as necessary.

• Respond to incoming calls promptly, assess needs, and either address them or direct calls to the appropriate team member.

• Assist with reimbursement queries, including insurance benefit verification, prior authorization, denials, appeals, and other reimbursement challenges.

• Provide billing and coding information related to specific products as required.

• Conduct general payer research.

• Investigate benefits and eligibility via phone and/or internet to ascertain patient coverage options for initiating therapy.

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

• Act as the main point of contact for a designated group of prescribers as necessary.

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

• Maintain accurate and thorough documentation of inquiries.

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

• Adhere to housekeeping, quality, production, safety, and environmental standards.

• 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 environment.

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

• Proficiency in MS Office applications, with database experience being a plus.

• Experience with 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 effectively.

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

• Strong customer service skills—patience to explain details and processes repeatedly, along with excellent phone presentation skills.

• Proven ability to address challenging customers in a professional manner.

• Ability to adapt in a fast-paced work environment and make decisions with minimal supervision.

• Advanced problem-solving skills.

• Ability to collaborate effectively 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 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 disability coverage.

• Long-term disability coverage.

• Life insurance.

• Discount programs.