Eligibility Analyst- REMOTE

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

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

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 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 (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.

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