Senior Eligibility Representative- Work from Home – Accredo

By | September 28, 2022

Job Responsibilities : Senior Eligibility Representative- Work from Home – Accredo

Salary : $17 – $26 an hour

Company : Cigna

Location : Remote US

Educational requirements : High School

The Patient Access Representative III performs 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. This role directly interfaces with external clients and requires a high level of independent judgment in order to establish and maintain effective relationships with clients to gain their trust and support. Relies on experience and knowledge of industry best practices to identify exposures to the company and facilitates leadership’s 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 and provide accurate status reporting to clients.

ESSENTIAL FUNCTIONS

Facilitates cross-functional resolution of drug coverage issues & proactively address researches & resolves issues impacting revenue optimization.

Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.

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.).

Directly interfaces with external clients.

Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.

Provide expert assistance to clients on patient status.

Liaison for company providing referral status reporting.

May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome.

Handle Escalations.

Use discretion & independent judgement in handling pt or more complex client complaints escalating as appropriate.

Completes other projects and additional duties as assigned.

QUALIFICATIONS

High school diploma or GED required bachelor’s degree preferred.

3-5 years of relevant experience.

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 innovative solutions.

If you will be working at home occasionally or permanently the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position we anticipate offering an hourly rate of 17 – 26 USD / hourly depending on relevant factors including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy balanced and feel secure. That’s why you’ll enjoy a comprehensive range of benefits with a focus on supporting your whole health. Starting on day one of your employment you’ll be offered several health-related benefits including medical vision dental and well-being and behavioral health programs. We also offer 401(k) with company match company paid life insurance tuition reimbursement a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs visit Life at Cigna .

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health well-being and peace of mind of those we serve. Together with colleagues around the world we aspire to transform health services making them more affordable and accessible to millions. Through our unmatched expertise bold action fresh ideas and an unwavering commitment to patient-centered care we are a force of health services innovation. When you work with us or one of our subsidiaries you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

Qualified applicants will be considered without regard to race color age disability sex childbirth (including pregnancy) or related medical conditions including but not limited to lactation sexual orientation gender identity or expression veteran or military status religion national origin ancestry marital or familial status genetic information status with regard to public assistance citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

Cigna has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama Alaska Arizona Arkansas Delaware Florida Georgia Hawaii Idaho Iowa Kansas Maryland Massachusetts Michigan Nebraska Ohio Pennsylvania Texas Utah Vermont and Washington State.

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