Eligibility Representative - Accredo - Work at Home

TheEligibility Representativeperforms specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes in order to successfully liaise with Payers, Pharma, Physicians, and Patients.

Relies on experience and knowledge of industry best practices to communicate knowledge of pending referrals that may have an adverse impact on company goals and the patient experience.

Acts as a liaison between both internal and external resources to reduce client abrasion, facilitate the timely processing of referrals.

This individual can proactively recognize cause and effect trends, identify and clarify patients' needs, and work towards solutions.

PRIMARY RESPONSIBILITIES:


* Facilitates cross-functional resolution of drug coverage issues & proactively address, research & resolves issues impacting referral turn-around time.


* Independently resolves basic patient claims issues using key subject matter knowledge.


* Prepares and reviews claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations.


* Demonstrates a technical proficiency to patient access functions.


* Effectively collaborates with internal departments to resolve issues or provide any needed information using professional communication at all times.


* Contacts benefit providers to gather policy benefits/limitations.


* Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).


* Performs 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 on department policies and procedures.


* Use discretion & independent judgement in handling patient or more complex client complaints, escalating as appropriate and when to triage as needed.


* Completes other projects and additional duties as assigned.

QUALIFICATIONS:


* High school diploma or GED required; bachelor's degree preferred.


* 1-2 years of Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.


* Intermediate data entry skills and working knowledge of Microsoft Office, Patient Access knowledge.


* Extensive knowledge of ESI products and services a must.


* Experience training and coaching less experienced staff with patience to explain details and processes repeatedly.


* Excellent phone presentation and communication skills.


* Demonstrated ability to handle challenging customers in a professional manner.


* 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 i...