Express Scripts Jobs – Eligibility Representative

Job Description:

As an Eligibility Representative, you will be part of a team passionate about helping our patients with billing and ensuring their access to life saving medications.

Job Responsibilities:

• Perform medical/pharmacy benefit verification requiring complex decision skills based on payer and process knowledge
• Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates and authorizations
• Facilitates cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time
• Independently resolve basic patient claims issues using key subject matter knowledge
• Effectively collaborate with internal departments to resolve issues or provide any needed information
• Contact benefit providers to gather policy benefits/limitations
• Coordinate and ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)

Job Requirements:

• Advanced problem solving skills and the ability to work collaboratively with other departments
• Excellent phone presentation and communication skills
• Demonstrated ability to handle difficult conversations in a professional manner
• Ability to adapt in a dynamic work environment and make decisions independently
• Strong data entry skills and computer skills

Qualification & Experience:

• Experience with health care, medical insurance terminology and patient access preferred
• High school diploma or GED
• 3-5 years of relevant working experience

Job Details:

Company: Express Scripts

Vacancy Type: Full Time

Job Location: Memphis, TN, US

Application Deadline: N/A

Apply Here

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