Role Description Delivers specific Senior Eligibility Representative tasks assigned by a supervisor within a dedicated Cystic Fibrosis team. Implements, updates, and maintains automated, direct connect, and/or manual eligibility data. May handle National Accounts or more complex accounts. Reconciles accounts for non-standard requests and provides technical support for electronic eligibility processing. Ensures customer data is installed accurately and timely. Analyzes customized client formats and may work directly with Systems to design formats. Provides recommendations to decrease errors. Demonstrates thorough technical knowledge of manual and automated eligibility. Completes day-to-day Senior Eligibility tasks independently, with access to guidance from senior team members. Tasks involve forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from junior team members. Cross-training in multiple systems and business areas of Patient Access is required to support broader team functionality and ensure seamless patient care.

Qualifications

• High school diploma or GED
• 2 plus years of relevant working experience required
• Experience with health care, medical insurance terminology and patient access preferred
• Strong data entry skills and computer skills
• Excellent phone presentation and communication skills
• Demonstrated ability to handle difficult conversations in a professional manner
• Ability to adapt in a dynamic work environment and make decisions independently
• Advanced problem-solving skills and the ability to work collaboratively with other departments

Requirements

• Facilitates cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time
• Independently resolve basic patient claims issues using key subject matter knowledge
• Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates and authorizations
• Effectively collaborate with internal departments to resolve issues or provide any needed information
• Contact benefit providers to gather policy benefits/limitations
• Coordinate and ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
• Perform medical/pharmacy benefit verification requiring complex decision skills based on payer and process knowledge

Benefits

• Comprehensive range of benefits focusing on whole health
• Health-related benefits including medical, vision, dental, and well-being and behavioral health programs
• 401(k) and company paid life insurance
• Tuition reimbursement
• A minimum of 18 days of paid time off per year and paid holidays
• Annual bonus plan eligibility