Eligibility Specialist
bcforwardIndianapolis, IN
Eligibility Specialist
bcforwardIndianapolis, INSenior L5
Eligibility Interviewers, Government ProgramsProject Management SpecialistsBusiness Operations Specialists, All Other
Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension FundsAll Other Miscellaneous Ambulatory Health Care ServicesOther Management Consulting Services
APPLY NOWBCforward is seeking a Eligibility and Monitoring Consultant to work hybrid in Indianapolis. Program Eligibility and Monitoring Consultant
Location: Indianapolis, IN- hybrid
Description:
We are seeking a Program Eligibility and Monitoring Consultant to join our dynamic team. The ideal candidate will have strong experience in patient assistance program eligibility operations, compliance monitoring, and data-driven process improvement and a proven ability to optimize eligibility workflows, uphold privacy requirements, and deliver actionable monitoring insights.
Responsibilities:
Operational Eligibility Management: Review insurance documentation against program rules and identify alternate funding program organizations.
Procedures and Processes: Strengthen and refine eligibility criteria application, improve operational processes, and train Eligibility Specialist staff with updated resources and process documents.
Privacy Compliance: Maintain an inventory of patient data locations, enforce access controls, apply data deletion tools, and uphold data retention policies.
Confidential Information Handling: Support and manage privileged and confidential information in a compliant manner.
Validation Monitoring: Execute monitoring plans to validate approved and denied applications, use analytics to identify patterns and discrepancies, collaborate with analytics teams, and present findings and recommendations to stakeholders.
Program Enhancements: Implement tools and processes to improve enrollment and monitoring, automate compliant data exchanges, update application documents, and support online tool development to enhance patient and HCP experience.
Project Management: Manage timelines, deliverables, and resources for eligibility and monitoring activities. Track progress, report status, and address issues or risks.
Required Skills & Qualifications:
- Patient assistance program. helping less privileges communities gain access to pharma solutions
- Experience with patient assistance programs, payer or benefits eligibility operations, and compliance monitoring.
- Proficiency in data analysis for validation, trend identification, and root-cause assessment. Knowledge of privacy, data retention, and access control practices for sensitive data.
- Strong project management skills with the ability to manage timelines, risks, and cross-functional collaboration.
- Clear written and verbal communication with attention to detail and documentation quality.
Experience level:
5+ years in program operations, eligibility, compliance, or related healthcare setting.
Preferred Skills:
Familiarity with PAP vendor platforms, CRM or case management systems, and workflow automation tools.
Experience collaborating with data analytics teams and building monitoring dashboards or reports.
Role's focus on patient-level eligibility verification, program integrity, and monitoring for a manufacturer-sponsored PAP, payer-side patient eligibility adjudication, PAP/hub operations, or program integrity/audit work
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Level
Senior L5
Location
Indianapolis, IN
Occupation
Eligibility Interviewers, Government Programs
Industry
Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
Posted
today