Eligibility Senior Representative - Accredo - Remote

The Eligibility Senior Representative plays an important role in helping patients navigate access to the medications they need. This position performs specialized patient access functions requiring an advanced understanding of insurance benefits and processes to successfully communicate with Payers, Pharma, Physicians, and Patients. Using experience and knowledge of industry best practices, this individual communicates updates on pending referrals that may have an adverse impact on the patient experience. This role proactively recognizes trends, identifies and clarifies patients’ needs, and works toward solutions that help create a smoother patient experience. What you’ll do to make a difference: Facilitate cross-functional resolution of drug coverage issues and proactively address, research, and resolve issues impacting referral turnaround time. Independently resolve basic patient claims issues using key subject matter knowledge. Prepare and review claims to ensure accuracy and alignment with payer requirements, including but not limited to codes, dates, and authorizations. Effectively collaborate with internal departments to resolve issues or provide needed information, always using professional communication. Contact benefit providers to gather policy benefits and limitations. Perform medical/pharmacy benefits verification requiring complex decision-making skills based on payer and process knowledge. Complete other projects and additional duties as assigned. What you’ll ne