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Eligibility Representative
3 months ago
Have you heard? Express Scripts and Accredo are now part of Cigna. Together, we've got big plans. How big, you ask? We want to change health care to make it more affordable, more personalized, and more focused on helping the whole person to achieve better health outcomes. And that's only the beginning. Read on to learn more about working with us.
As an Eligibility Representative, you will be responsible on providing a path to payment and reimbursement for Accredo patients' medications.
What you'll do:
- Facilitates cross-functional resolution of drug coverage issues and will proactively address, research & resolve issues resulting in timely onboarding of specialty patients.
- Performs medical/pharmacy benefit verification by contacting insurance companies or using provider portals for drug coverage and benefits.
- 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.
- Communicate with patients, prescriber's and clients
- Effectively collaborates with internal departments to resolve issues or provide any needed information always using professional communication.
- Use discretion and independent judgement in handling patient or more complex client complaints and escalating to leadership as appropriate.
- Meet or Exceed performance expectations
- Completes other projects and additional duties as assigned.
What you'll need:
- High school diploma or GED required.
- 2-3 years of relevant working experience.
- Pharmacy/Specialty pharmacy experience a plus
- Health care or professional office experience with medical insurance knowledge and terminology and experience in patient access preferred.
- Ability to train, learn, and meet performance goals in a remote working environment
- Ability to make decisions with minimal supervision
- Excellent communication skills, including written, and oral phone presentation
- Tech Savvy
- Proficient in Microsoft Office Products- Word, Outlook, Excel
- Problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.
Training Schedule: Monday through Friday 8:00am-5:00pm Central Standard Time. The training will be for approximately the first 8-12 weeks of employment.
Post-training schedule: This will be an eight-hour shift 10:00am-7:00pm CST, Monday through Friday.
ABOUT ACCREDO
Through our range of health care products and services offered, Accredo team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis and growth hormone deficiency. In addition to health care products, we provide comprehensive management services – including outcomes measurement, counseling, clinical care management programs, social services and reimbursement services. By performing in these very high-touch roles, employees have a daily opportunity to make a positive impact on their patients' lives.
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.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group 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.
