Senior Eligibility Representative - Accredo - Remote

**Job Summary:** Delivers specific Senior Eligibility Representative tasks assigned by a supervisor within a dedicated Cystic Fibrosis team. 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 and provides technical support for electronic eligibility processing. Ensures customer data is installed accurately and timely. Analyzes customized client formats and may work directly with Systems to design formats. Provides recommendations to decrease errors. Demonstrates thorough technical knowledge of manual and automated eligibility. Completes day\-to\-day Senior Eligibility tasks independently, with access to guidance from senior team members. Tasks involve forward planning and anticipation of needs/issues. Resolves non\-routine issues escalated from junior team members. Cross\-training in multiple systems and business areas of Patient Access is required to support broader team functionality and ensure seamless patient care. **Job Description:** Delivers advanced administrative and business services in Eligibility as part of a dedicated Cystic Fibrosis team. Implements and maintains eligibility for benefits, including automated, direct connect, and manual data. Interacts with internal partners and external clients/vendors. Generates reports to identify and resolve discrepancies and identifies process improvement opportunities. May negotiate and resolve eligibility issues with clients and provide technical support for electronic processing. Ensures customer data is installed accurately and timely. May work with client formats and internal Systems to resolve errors and technical issues. Demonstrates advanced knowledge of manual and automated eligibility, reporting tools, and systems. Issues may be complex and require independent judgment. Works under defined procedures with minimal supervision. Cross\-training in multiple systems and business areas of Patient Access is required, enabling team members to support various functions and ensure continuity of care for patients with complex needs. **What you’ll do:** * Facilitates cross\-functional resolution of drug coverage issues proactively address, research resolve issues impacting referral turn\-around time * Independently resolve basic patient claims issues using key subject matter knowledge * Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates and authorizations * Effectively collaborate with internal departments to resolve issues or provide any needed information * 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.) * Perform medical/pharmacy benefit verification requiring complex decision skills based on payer and proce