ELIGIBILITY ASSOCIATE

POSITION SUMMARY:

The primary function/purpose of this job.

The primary goal of this position is to effectively transition patients’ information, received via fax and/or client partner download, into our client database program and prepare necessary files to expedite the process of getting patients started on client product. This entails performance of part or all of the essential job functions listed below.

ESSENTIAL FUNCTIONS:

- Performs all aspects of electronic claims and rejection resolution

- Ensures accounts requiring authorizations and re-authorizations are identified, secured, and updated in RX Home prior to each shipment; notifies as appropriate if authorization cannot be obtained

- Contacts benefit providers to gather policy benefits/limitations to ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective dates, levels of care, authorizations, etc)

- Handles inbound client calls and written correspondence regarding patient eligibility

- Provides inbound phone call support to the prior authorization team giving personal attention to the resolution of customer issues having to do with the status of letter requests or physician review process

- Supports cross-functional departments in resolution of eligibility issues (claims, contact center, account management, service delivery, etc)

- Negotiates pricing for non-contracted payers and authorizes patient services and ensures proper pricing is indicated in RxHome; Works referrals

- Completes other projects and additional duties as assigned

QUALIFICATIONS:

- High school diploma or GED required, Bachelor's degree preferred

- 2-3 years of relevant working experience to include 1 year of health care experience with medical insurance knowledge and terminology; Patient Access knowledge

- Billing and Reimbursement experience, and knowledge of RxHome, are strongly desired

- Intermediate data entry skills and working knowledge of MS Office

- 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