Eligibility Representative, Specialty
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Job Description
Insurance verification coordinator supporting specialty pharmacy and infusion patients for Evernorth. Verifying coverage, authorizations, reimbursement documents, and financial assistance requirements.
Responsibilities:
- Verify patient insurance coverage, calculate estimated costs, and document details in patient profiles
- Enter and update patient demographics in the system
- Generate coverage and financial responsibility quotes and review benefits with patients by phone
- Track, monitor, and secure required insurance and reimbursement documents
- Obtain prior authorizations and coordinate financial assistance forms, payment agreements, and waivers
- Help train new employees during onboarding
- Organize and prioritize daily tasks to meet productivity and quality standards
- Create new hospital and physician codes as needed
- Partner with internal teams to support reimbursement workflows and client service
- Research reimbursement issues and contribute to continuous improvement efforts
- Support specialty pharmacy and infusion services in partnership with hospitals and health systems
Requirements:
- High school diploma or GED
- 1+ year of insurance verification, prior authorization, or related experience in a healthcare setting
- Knowledge of medical terminology
- Proficient computer skills, including Microsoft Office
- Strong math, communication, and organizational skills
- Experience with payer websites and coordination of benefits preferred
- Knowledge of pharmacy vs. medical payers and authorization processes preferred
- Familiarity with plan formularies and authorization requirements preferred
- Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload for home-based work
Benefits:
- Annual bonus plan eligibility
- Medical, vision, and dental benefits starting on day one
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Remote work arrangement
- Internet connection requirement supported through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload
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