Eligibility Representative - Accredo - Remote

The job profile for this position is Eligibility Representative, which is a Band 1 Professional Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. 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 accuracyKnowledge of medical, pharmacy, insurance, and specialty therapy terminologyAbility to interpret referrals, prescriptions, insurance, and clinical documentsClear communication and patient-focused serviceOrganization, research, and problem-solving skillsAbility to prioritize work and meet performance expectationsCommitment 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 If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. 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. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.