Eligibility Senior Representative - Accredo- Remote
Posted 2025-08-15
Remote, USA
Full Time
Immediate Start
About the position
The Eligibility Senior Representative at Accredo plays a vital role in ensuring patient access to medications by performing eligibility functions that require a deep understanding of insurance benefits and internal processes. This position involves liaising with various stakeholders, including payers, pharmaceutical companies, physicians, and patients, to facilitate the authorization of medication payments.
Responsibilities
• Deliver straightforward administrative and/or other basic business services in Eligibility.
,
• Implement and maintain eligibility for benefits.
,
• Ensure customer data is input accurately and timely.
,
• Contact benefit providers to gather policy benefits/limitations to ensure re-authorization of prescription medications.
,
• Coordinate and ensure services provided will be reimbursable, including deductible amounts, co-payments, effective date, levels of care, and authorization.
,
• Perform medical/pharmacy benefit verification requiring complex decision skills based on payer and process knowledge.
,
• Provide expert assistance to internal and external clients on patient status.
,
• Handle escalations with expert understanding of department policies and procedures.
,
• Use discretion and independent judgment in handling patient or more complex client complaints, escalating as appropriate and triaging as needed.
Requirements
• High school diploma or GED required.
,
• 1+ years of experience with medical insurance eligibility and prior authorization strongly preferred.
,
• 2+ years of healthcare experience, medical terminology, and experience in patient access, strongly preferred.
,
• Intermediate data entry skills with Microsoft Office; Outlook and Excel, required.
,
• Knowledge of ESI/Accredo products and services, strongly preferred.
,
• Professional phone presentation and communication skills, required.
,
• 2+ years of experience handling challenging situations in a professional manner, required.
,
• Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
,
• Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.
Nice-to-haves
Benefits Apply tot his job
The Eligibility Senior Representative at Accredo plays a vital role in ensuring patient access to medications by performing eligibility functions that require a deep understanding of insurance benefits and internal processes. This position involves liaising with various stakeholders, including payers, pharmaceutical companies, physicians, and patients, to facilitate the authorization of medication payments.
Responsibilities
• Deliver straightforward administrative and/or other basic business services in Eligibility.
,
• Implement and maintain eligibility for benefits.
,
• Ensure customer data is input accurately and timely.
,
• Contact benefit providers to gather policy benefits/limitations to ensure re-authorization of prescription medications.
,
• Coordinate and ensure services provided will be reimbursable, including deductible amounts, co-payments, effective date, levels of care, and authorization.
,
• Perform medical/pharmacy benefit verification requiring complex decision skills based on payer and process knowledge.
,
• Provide expert assistance to internal and external clients on patient status.
,
• Handle escalations with expert understanding of department policies and procedures.
,
• Use discretion and independent judgment in handling patient or more complex client complaints, escalating as appropriate and triaging as needed.
Requirements
• High school diploma or GED required.
,
• 1+ years of experience with medical insurance eligibility and prior authorization strongly preferred.
,
• 2+ years of healthcare experience, medical terminology, and experience in patient access, strongly preferred.
,
• Intermediate data entry skills with Microsoft Office; Outlook and Excel, required.
,
• Knowledge of ESI/Accredo products and services, strongly preferred.
,
• Professional phone presentation and communication skills, required.
,
• 2+ years of experience handling challenging situations in a professional manner, required.
,
• Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
,
• Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.
Nice-to-haves
Benefits Apply tot his job