Eligibility Analyst - Remote

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Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Eligibility Analyst - Remote

Job Description

The Eligibility Analyst is responsible for representing commercial or government programs' eligibility and acts as a subject matter expert for department projects, Run functions and escalated client issues. This role is responsible for mentoring and training the Eligibility Specialist.

Responsibilities

• Serves as subject matter expert representing eligibility on file process for new and existing clients and department projects; monitors eligibility mailbox and Prime Resolution daily, participates in workstream meetings, assists with providing information regarding business requirements, and performs User Acceptance Testing
• Serves as primary contact for external clients, vendors and Prime's Client Engagement team for requests and escalated issues; responsible for facilitating timely resolution
• Identifies and implements improvements for existing Eligibility processes
• Participates in peak season planning and execution
• May manage Medicaid subrogation activities including monitoring batch claim files, outgoing eligibility files, verification of letters of authority and some claims analysis.
• Other duties as assigned
  
  

Education & Experience

• Bachelor's degree in IT, Business, Liberal Arts, Science or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED required
• 2 years of experience in healthcare, PBM, Eligibility or claims processing
• Must be eligible to work in the United States without need for work visa or residency sponsorship
  
  

Additional Qualifications

• Ability to work in a collaborative team based environment
• Strong oral and written communication skills
• Strong organizational and time management skills
• Problem solving skills with strong attention to detail
• Ability to implement defined objectives and to act independently
  
  

Preferred Qualifications

• Previous PBM Experience
• Experience working in eligibility or enrollment
• Experience with Microsoft Excel
  
  

Physical Demands

• Ability to work a flexible schedule including weekends, holidays, overtime, on call, and shifts outside of Prime's core business hours of 9:00 a.m. to 3:00 p.m.
• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
  
  

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Potential pay for this position ranges from $53,000.00 - $85,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail.

_Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   _

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.

If you have questions about this posting, please contact support@lensa.com