Senior Eligibility Representative

This is a fully remote position, open to applicants in Arizona, +2 more states.

📋 Description

• Perform investigations into medical and pharmacy benefits to verify eligibility, coverage, payer requirements, and patient financial responsibilities.

• Confirm insurance eligibility, detail benefits, identify coverage limitations, and ascertain documentation requirements to ensure timely processing of referrals.

• Recognize prior authorization, appeal processes, step therapy, quantity limits, and other utilization management criteria that may impact access to therapy.

• Investigate and resolve intricate reimbursement, eligibility, and coverage challenges in collaboration with payers, providers, patients, and internal teams.

• Provide education to patients regarding copay, coinsurance, and their financial responsibilities.

• Aid in the enrollment process for copay assistance, manufacturer support, and patient assistance programs that are available.

• Accurately document referral activities in company systems while adhering to departmental protocols for service quality and compliance.

• Oversee assigned referrals, manage escalations, and contribute to minimizing delays in therapy initiation and continuity of treatment.

⛳️ Requirements

• High school diploma or equivalent qualification.

• A minimum of 1 year of experience in healthcare, specialty pharmacy, patient access, reimbursement, insurance verification, or a similar field.

• Familiarity with insurance eligibility, coverage requirements, reimbursement processes, prior authorization, or payer stipulations.

• Exceptional attention to detail and strong problem-solving capabilities.

• Capacity to manage multiple priorities while ensuring accuracy.

• Excellent verbal and written communication skills.

• Proficiency in explaining coverage and financial details in a professional manner.

• Competence in using computer systems and accurately documenting work activities.

• Experience in conducting medical and pharmacy benefit investigations is preferred.

• Background in supporting specialty pharmacy, patient access, reimbursement, or new referral intake processes is preferred.

• Familiarity with complex medical and pharmacy benefit frameworks or payer requirements is preferred.

• Knowledge of specialty drug reimbursement, copay assistance, manufacturer support programs, or patient assistance programs is preferred.

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

🏝️ Benefits

• Access to copay assistance, manufacturer support programs, and patient assistance programs, as applicable.

• Opportunity for remote work arrangements.

• Implementation of a tobacco-free policy.

• Reasonable accommodations provided for the online application process.