Job Description
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. Apply tot his job