Eligibility Analyst

Prime Therapeutics; Garden City (ID); On-site; USD 53,000 - 85,000; Full time

Job summary

A healthcare solutions provider is seeking an Eligibility Analyst to serve as a subject matter expert for eligibility files and act as the primary contact for clients and vendors. This role involves mentoring, implementing process improvements, and requires a bachelor's degree along with relevant experience. Candidates must be eligible to work in the U.S. without visa sponsorship.

Qualifications

• 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.

Responsibilities

• Serve as subject matter expert for eligibility file processes.
• Primary contact for clients and vendors for escalated issues.
• Identify and implement improvements for Eligibility processes.

Skills

Problem solving skills

Strong organizational and time management skills

Strong oral and written communication skills

Collaborative team-based work

Education

Bachelor’s degree in IT, Business, Liberal Arts, Science or related area

High school diploma or GED

Tools

Microsoft Excel

Job description

Overview

Eligibility Analyst

Our work matters. We help people get the medicine they need to feel better and live well. This role represents commercial or government programs' eligibility and acts as a subject matter expert for department projects, Run functions and escalated client issues. The position includes mentoring and training the Eligibility Specialist.

Responsibilities

• Serve as subject matter expert representing eligibility on file process for new and existing clients and department projects; monitor eligibility mailbox and Prime Resolution daily, participate in workstream meetings, assist with information regarding business requirements, and perform User Acceptance Testing.
• Serve as primary contact for external clients, vendors and Prime’s Client Engagement team for requests and escalated issues; facilitate timely resolution.
• Identify and implement improvements for existing Eligibility processes.
• Participate 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.

Minimum 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; high school 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.

Other Requirements

Must be eligible to work in the United States without the 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.

Compliance, Benefits and Equal Opportunity

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. Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. Prime retains the right to change or assign other duties to this job.

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: https://www.primetherapeutics.com/benefits.

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 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 [e-mail].

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