Eligibility Analyst

Prime Therapeutics; Salem (OR); On-site; USD 53,000 - 85,000; Full time

Job summary

A healthcare services company is seeking an Eligibility Analyst in Salem, Oregon. This role involves managing eligibility processes, mentoring staff, and serving as a primary contact for client issues. Candidates must have a bachelor's degree and 2 years of relevant experience in healthcare or claims processing. This position offers a competitive salary range from $53,000 to $85,000 based on skills and experience.

Benefits

Comprehensive health benefits

Retirement plan options

Career advancement opportunities

Qualifications

• 2 years of experience in healthcare, PBM, Eligibility or claims processing.
• Strong attention to detail and organizational skills.
• Must be eligible to work in the United States without need for work visa or residency sponsorship.

Responsibilities

• Represent eligibility on file processing for new and existing clients.
• Serve as primary contact for external clients and facilitate timely resolutions.
• Identify and implement improvements for existing Eligibility processes.

Skills

Team collaboration

Communication skills

Organizational skills

Problem-solving skills

Education

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

Tools

Microsoft Excel

Job description

Overview

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

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

• Represents eligibility on file processing 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; facilitates 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

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; 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

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

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. In addition, 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 (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 (including pregnancy), 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 [e-mail].