Job Description
The Sr. Eligibility Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes in order to successfully perform medical/pharmacy benefit verifications and obtain Prior Authorizations. This role directly interfaces with external clients and requires a high level of independent judgment in order to identify exposures to the company and facilitates knowledge of pending referrals that may have an adverse impact on company goals and the patient experience. Use your knowledge and resources to reduce client and patient abrasion by facilitating the timely processing of referrals and provide accurate status updates to internal counterparts.
- 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
- 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.)
- Handle Escalations
- Completes other projects and additional duties as assigned
Qualifications: - High school diploma or GED required, bachelor's degree preferred
- Minimum of 3 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
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 19 - 28 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 Group .
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: 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.
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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Job Tags
Hourly pay, Permanent employment, Work at office, Local area,