Eligibility Senior Representative - Accredo - Remote
$39,520–$60,320 year
RemoteUnited States
Job Summary
Review patient accounts, insurance requirements, and authorization status to determine shipment readiness. Identify and resolve barriers preventing medication shipment, including claim rejections, reimbursement issues, and payer requirements. Coordinate activities for clearance, validate authorizations, and research coverage challenges to determine next steps and escalation needs. Partner with pharmacy operations, providers, payers, and manufacturers to support timely treatment outcomes. Escalate high-risk shipment barriers that could cause therapy interruption or financial impact. Communicate status and trends clearly to business partners and external contacts while serving as a subject matter resource for complex clearance questions.
Required Qualifications
- Must be able to work Monday - Friday 11:00AM - 8:00PM EST
- High school diploma or GED
- Minimum of 3 years of experience in healthcare, specialty pharmacy, patient access, insurance verification, reimbursement, revenue cycle management, or a related field
- Knowledge of medical or pharmacy insurance benefits, authorization requirements, payer requirements, claims, and reimbursement processes
- Strong problem-solving and analytical skills, with the ability to research complex issues and identify practical solutions
- Excellent verbal and written communication skills with the ability to work professionally with internal and external partners
- Ability to manage multiple priorities in a fast-paced environment while maintaining accuracy, follow-through, and attention to detail
- Ability to work independently, use sound judgment, and collaborate across teams to resolve shipment barriers
- 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
Desired Qualifications
- Associate or bachelor's degree
- Experience in specialty pharmacy, advanced therapy, patient access, or shipment clearance operations
- Experience resolving claim rejections, coverage issues, reimbursement barriers, or payer-related shipment delays
- Experience working with healthcare providers, payer organizations, manufacturer contacts, pharmacy operations, or cross-functional business partners
- Knowledge of Express Scripts, Evernorth, or related pharmacy systems, products, and services
- Experience supporting process improvement, training, workflow enhancements, or operational projects
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