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Prime Therapeutics logo
Prime Therapeutics

Reimagining pharmacy management to provide the same care we would want for our loved ones

Eligibility Analyst

AnalystAnalystOtherRemoteMid LevelTeam 1,001-5,000Since 1998H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

93 days ago

Salary

$53K - $85K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Eligibility Analyst

Prime Therapeutics

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role 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. - 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. Qualifications - 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. Requirements - 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. Benefits 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 and click on the "Benefits at a glance" button for more detail.

Job Requirements

  • 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.
  • 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.

Benefits

  • 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 and click on the "Benefits at a glance" button for more detail.

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