Eligibility Senior Representative - Accredo- Remote

Cigna

407d • Hybrid

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.

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.

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.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED