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Prime Therapeutics · 1 day ago

Eligibility Analyst- REMOTE

United States

Full-time

Remote

Entry, Mid Level

$53K/yr - $85K/yr

2+ years exp

Prime Therapeutics is a unique PBM focused on connecting care for those they serve. The Eligibility Analyst is responsible for representing eligibility for commercial or government programs and acts as a subject matter expert while mentoring Eligibility Specialists.

Health CarePharmaceutical

No H1B

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

Qualification

Healthcare experienceEligibility processingClaims processingMicrosoft ExcelCommunication skillsOrganizational skillsProblem solving skillsTeam collaborationAttention to detail

Required

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