Eligibility Representative 

Job Description

REQUIREMENTS

• High school diploma or GED required, bachelor’s degree preferred.
• 2+ years of relevant working experience.
• Health care or professional office experience with medical insurance knowledge and terminology and experience in patient access preferred.
• Pharmacy/Specialty pharmacy experience a plus
• Proficient in Microsoft Office Products- Word, Outlook, Excel
• Excellent communication skills, including written, and oral phone presentation.
• Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
• Problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.

RESPONSIBILITES

• Performs medical/pharmacy benefit verification by contacting insurance company or using provider portals for drug coverage and benefits.
• Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues resulting in timely onboarding of specialty patients
• Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
• Perform insurance review on day of shipment to ensure insurance criteria is met for reimbursement and reduce the risk of bad debt
• Effectively collaborates with internal departments to resolve issues or provide any needed information using professional communication at all times.
• Use discretion & independent judgement in handling patient or more complex client complaints, escalating to leadership as appropriate.
• Completes other projects and additional duties as assigned.

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