Senior Eligibility Representative

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

📋 Description

• Perform medical and pharmacy benefit investigations to verify eligibility, coverage, payer requirements, and patient financial obligations.

• Confirm insurance eligibility, benefit specifics, coverage constraints, and documentation necessities for the prompt processing of referrals.

• Identify requirements for prior authorization, appeals, step therapy, quantity limits, and other utilization management protocols.

• Investigate and address complex reimbursement, eligibility, and coverage challenges with payers, providers, patients, and internal stakeholders.

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

• Support enrollment in copay assistance, manufacturer support, and patient assistance programs.

• Accurately document referral activities in company systems and adhere to departmental protocols.

• Track assigned referrals, manage escalations, and assist in minimizing delays in therapy initiation and continuity of treatment.

⛳️ Requirements

• High school diploma or its equivalent.

• At least 1 year of experience in healthcare, specialty pharmacy, patient access, reimbursement, insurance verification, or a related discipline.

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

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

• Capability to juggle multiple priorities while ensuring accuracy.

• Effective verbal and written communication skills.

• Ability to professionally convey coverage and financial information.

• Proficient in using computer systems and accurately documenting work.

• For remote positions, a cable broadband or fiber optic internet service 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.

• Option for remote work.

• Requirement for home working includes cable broadband or fiber optic internet service with at least 10Mbps download and 5Mbps upload speed.