WORK SHIFT: Monday - Friday, 7a - 4p
RESPONSIBILITIES:
Facilitate cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization.
Perform medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
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.).
Interface with external clients.
Perform medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
Provide expert assistance to clients on patient status.
Liaison for company providing referral status reporting.
Negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in Rx Home.
Handle Escalations.
Use discretion & independent judgement in handling patient or more complex client complaints, escalating as appropriate.
Complete other projects and additional duties as assigned.
QUALIFICATIONS:
High school diploma or GED required, bachelor’s degree preferred.
3+ years of relevant experience eligibility 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.
Extensive knowledge of ESI products and services a must.
Experience training and coaching less experienced staff with patience to explain details and processes repeatedly.
Excellent communication skills. Including phone calls, written, and meeting presentation.
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.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, 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), 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, click here.
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.