Eligibility Analyst, Specialty - Evernorth- Remote
Core
Resolve complex eligibility and authorization issues to strengthen revenue cycle and patient access processes for specialty pharmacy and infusion therapies.
Role type
Specialty Eligibility Analyst
Builds
Accurate reimbursement workflows and patient access processes
Domain
Healthcare / Specialty Pharmacy / Revenue Cycle
Deliverable
dashboards & analysis
Required skills
Medical terminology, Microsoft Office, insurance verification, claims analysis, payer requirements knowledge, process improvement, report generation
Preferred skills
Coordination of benefits, prior authorization, audit support, team education
Responsibilities
Serve as liaison between Intake and Revenue Cycle teams to resolve escalated insurance verification and authorization concerns; Analyze escalated cases to identify root causes and process gaps; Recommend process improvements to reduce errors and improve efficiency; Provide expert guidance on payer requirements, contract pricing, and test claims; Generate reports summarizing issues, trends, and recommendations for leadership; Support audits, quality reviews, and revenue cycle initiatives.
