Senior Eligibility Representative

This is a fully remote position, open to applicants in Arizona, +3 more states.

📋 Description

• Assess patient accounts, insurance criteria, authorization statuses, and coverage specifics to ensure readiness for shipment.

• Identify and address obstacles that may hinder medication shipment, such as claim denials, reimbursement challenges, benefit issues, and payer guidelines.

• Organize benefit assessments, claim resolutions, authorization confirmations, and payer requirement evaluations to facilitate patient shipments.

• Investigate coverage and reimbursement obstacles and outline next steps, escalation requirements, and resolution strategies.

• Collaborate with pharmacy operations, patient access teams, healthcare providers, payers, manufacturers, and internal parties to ensure timely shipment results.

• Report high-risk shipment barriers that could lead to therapy interruptions, treatment delays, patient dissatisfaction, or financial repercussions.

• Relay shipment statuses, issue resolutions, and trends to business partners and external stakeholders.

• Act as a subject matter expert for intricate shipment clearance inquiries, insurance prerequisites, and patient access challenges.

• Assist in process enhancements, training, best-practice dissemination, and special initiatives aimed at improving shipment clearance and patient access results.

⛳️ Requirements

• Must be available to work Monday–Friday, 11:00 AM–8:00 PM EST.

• High school diploma or GED is required.

• At least 3 years of experience in healthcare, specialty pharmacy, patient access, insurance verification, reimbursement, revenue cycle management, or a related area.

• Familiarity with medical or pharmacy insurance benefits, authorization requirements, payer expectations, claims, and reimbursement procedures.

• Strong analytical and problem-solving abilities.

• Excellent verbal and written communication skills.

• Capability to handle multiple priorities in a fast-paced setting while ensuring accuracy, follow-through, and attention to detail.

• Ability to work autonomously, exercise sound judgment, and collaborate effectively across teams.

• For remote work, internet must be provided through a cable broadband or fiber optic service with speeds of at least 10 Mbps download/5 Mbps upload.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical benefits available from day one.

• Vision benefits starting on day one.

• Dental benefits commencing on day one.

• Well-being and behavioral health programs available from day one.

• 401(k) plan.

• Company-funded life insurance.

• Tuition reimbursement program.

• A minimum of 18 days of paid time off each year.

• Paid holidays.

• Leaves of absence.