As an Eligibility Representative, you’ll play an essential role in onboarding patients who need specialty pharmacy services. You’ll organize referral information, maintain complete records, and communicate with patients, prescribers, and healthcare providers. Your work will help reduce delays, improve care coordination, and create a smooth, dependable onboarding experience.

Here’s a little more on how you’ll make a difference:

PRIMARY RESPONSIBILITIES:

• Create and maintain complete patient profiles by accurately entering and updating demographic, prescription, insurance, prescriber, and relevant clinical information in internal systems.
• Review, validate, classify, and route incoming referrals and supporting documents according to established intake workflows and case requirements.
• Evaluate referral and prescription documentation, using knowledge of specialty medications, therapies, and treatment categories to determine next steps and appropriate case routing.
• Research and resolve missing, incomplete, or conflicting patient, prescriber, insurance, prescription, and clinical information to prevent processing delays.
• Communicate and collaborate with patients, prescribers, clients, healthcare providers, insurance representatives, and internal partners to complete referrals, remove barriers, and support timely access to therapy.
• Perform quality checks and complete required documentation, system updates, corrective actions, and task handoffs while following Standard Operating Procedures, regulatory requirements, and privacy standards.
• Manage a high volume of referrals while consistently meeting productivity, accuracy, quality, and turnaround-time expectations.

KEY SKILLS AND COMPETENCIES

• Attention to detail and data accuracy
• Knowledge of medical, pharmacy, insurance, and specialty therapy terminology
• Ability to interpret referrals, prescriptions, insurance, and clinical documents
• Clear communication and patient-focused service
• Organization, research, and problem-solving skills
• Ability to prioritize work and meet performance expectations
• Commitment to quality, confidentiality, and compliance

QUALIFICATIONS:

• Minimum of 1 year of experience in a healthcare or health insurance setting​
• Minimum of 1 year of customer service experience ​
• Working knowledge of pharmacy (PBM) benefits and medical benefits, with the ability to interpret plan details accurately.
• Ability to manage detailed, repetitive work in a structured environment while maintaining consistency and quality.
• Strong written and verbal communication skills appropriate for professional interactions with payer representatives.
• High School Diploma or equivalent.
• Must live and work remotely in one the following states: South Carolina or Arizona