21 days old

Eligibility Senior Representative

Cigna
Phoenix, AZ 85003
  • Job Code
    20015562
The Eligibility Sr. Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes in order to successfully liaise with Payers, Pharma, Physicians and Patients. Delivers specific delegated tasks assigned by a supervisor. Implements, updates, and maintains automated, direct connect and/or manual eligibility data. May handle National Accounts or more complex accounts. Reconciles accounts for non-standard requests. May provide technical support for the electronic procession of eligibility. Ensures customer data is installed accurately and timely. Analyzes formats that are customized directly by the client. May work directly with Systems to design formats. Provides recommendations to decrease errors. Thorough technical knowledge of manual and automated eligibility. Completes day-to-day Eligibility tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members.

ESSENTIAL FUNCTIONS

  • Completes other projects and additional duties as assigned.
  • Use discretion & independent judgement in handling pt or more complex client complaints, escalating as appropriate.
  • Handle Escalations.
  • May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome.
  • Liaison for company providing referral status reporting.
  • Provide expert assistance to clients on patient status.
  • Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
  • Directly interfaces with external clients.
  • Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
  • Contacts benefit providers to gather policy benefits/limitations.
  • Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
  • Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization.

QUALIFICATIONS

  • High school diploma or GED required, bachelor's degree preferred.
  • 3-5 years of relevant working 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 phone presentation and communication skills.
  • 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.

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

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.





Posted: 2020-09-04 Expires: 2020-10-03
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Eligibility Senior Representative

Cigna
Phoenix, AZ 85003

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