Eligibility Representative, Specialty - Evernorth- Remote
Core
Verify patient insurance coverage, calculate estimated costs, and coordinate reimbursement requirements to ensure patients access specialty pharmacy and infusion care.
Role type
Insurance verification coordinator (specialty pharmacy)
Builds
Coverage quotes, financial responsibility documents, and reimbursement workflows for specialty pharmacy and infusion services
Domain
Healthcare / Specialty Pharmacy
Deliverable
dashboards & analysis
Required skills
Insurance verification, prior authorization, medical terminology, data entry, benefits review, document management, math, organizational skills
Preferred skills
Payer website coordination, pharmacy vs. medical payer knowledge, formulary familiarity
Responsibilities
Verify patient insurance coverage and calculate estimated costs; Enter and update patient demographics; Generate coverage and financial responsibility quotes; Obtain prior authorizations and coordinate financial assistance forms; Research reimbursement issues and contribute to process improvements; Support onboarding by training new employees
Seniority
Entry-level, individual contributor