Sr. Coord, Individualized Care (Reimbursement Coordinator)

What Individualized Care contributes to Cardinal Health

The Sr. Coord, Individualized Care (Reimbursement Coordinator) supports patient access to therapy through Reimbursement Support Services in accordance with the program business rules. This position is responsible for guiding the patient through the various process steps of their patient journey to therapy. These steps include patient referral intake, investigating all patient health insurance benefits, and proactively following up with various partners including the insurance payers, specialty pharmacies, support organizations, and the patient/physician to facilitate coverage and dispense of product in a timely manner.

Qualifications

• Previous customer service experience is preferred

• High School diploma or equivalent preferred

• Patient Support Service experience, preferred

• Clear knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers' policies and guidelines for coverage, preferred

• Knowledge of DME, MAC practices, preferred

• Clear understanding of Medical, Supplemental, and pharmacy insurance benefit practices, preferred

• 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience

• 1-2 years' experience with Prior Authorization and Appeal submissions

• Ability to work with high volume production teams with an emphasis on quality

• Intermediate to advanced computer skills and proficiency in Microsoft Office including but not limited to Word, Outlook, and preferred Excel capabilities

• Previous medical experience, preferred

• Bilingual is preferred

What is expected of you and others at this level

• Experience in supporting time sensitive requests and prioritization of assignments and working with a sense of urgency

• Investigate and resolve patient/physician inquiries and concerns in a timely manner

• Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate

• Must be able to manage multiple concurrent assignments.

• Must communicate clearly and effectively in both a written and verbal format

• Proactive follow-up with various contacts to ensure patient access to therapy

• Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments

• In-depth knowledge in technical or specialty area

• Applies advanced skills to resolve complex problems independently

• May modify process to resolve situations

• Works independently within established procedures; may receive general guidance on new assignments

• May provide general guidance or technical assistance to less experienced team members

• Adaptable and Flexible

• Self-Motivated and Dependable

• Problem Solving

• Strong customer support skills and professional experience working with medical providers

• Team Spirited

• Punctual and Efficient

• Great work attitude

Responsibilities

• First point of contact on inbound calls and determines needs and handles accordingly

• Creates and completes accurate applications for enrollment with a sense of urgency

• Scrutinizes forms and supporting documentation thoroughly for any missing information or new information to be added to the database

• Conducts outbound correspondence when necessary to help support the needs of the patient and/or program

• Provides detailed activity notes as to what appropriate action is needed for the Benefit Investigation processing

• Working alongside teammates to best support the needs of the patient population o Will transfer caller to appropriate team member (when applicable)

• Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance

• Update internal treatment plan statuses and external pharmacy treatment statuses

• Maintain accurate and detailed notations for every interaction using the appropriate database for the inquiry

• Self-audit intake activities to ensure accuracy and efficiency for the program

• Make all outbound calls to patient and/or provider to discuss any missing information and/or benefit related information

• Notify patients, physicians, practitioners, and or clinics of any financial responsibility of services provided as applicable

• Assess patient's financial ability to afford therapy and provide hand on guidance to appropriate financial assistance

• Follow through on all benefit investigation rejections, including Prior Authorizations, Appeals, etc. All avenues to obtain coverage for the product must be fully exhausted

• Track any payer/plan issues and report any changes, updates, or trends to management

• Search insurance options and explain various programs to the patient while helping them to select the best coverage option for their situation

• Handle all escalations based upon region and ensure proper communication of the resolution within required timeframe agreed upon by the client

• Serve as a liaison between client sales force and applicable party

• Mediate situations in which parties disagree and facilitate a positive outcome

• Concurrently handle multiple outstanding issues and ensure all items are resolved in a timely manner to the satisfaction of all parties

• Responsible for reporting any payer issues by region with the appropriate team

• Log and maintain a reconciliation report for all Field requests to send to client at their designated preferred date range

• Support team with call overflow and intake when needed

• As needed conduct research associated with issues regarding the payer, physician's office, and pharmacy to resolve issues swiftly

TRAINING AND WORK SCHEDULES:

• Your new hire training will take place 8:00am-5:00pm CST, mandatory attendance is required.

• This position is full-time (40 hours/week).

• Employees are required to have flexibility to work any of our shift schedules during our normal business hours of Monday-Friday, 7:00am- 7:00pm CST.

REMOTE DETAILS:

• You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet.

• We will provide you with the computer, technology and equipment needed to successfully perform your job.

• You will be responsible for providing high-speed internet. Internet requirements include the following:

o Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable.

o Download speed of 15Mbps (megabyte per second)

o Upload speed of 5Mbps (megabyte per second)

o Ping Rate Maximum of 30ms (milliseconds)

o Hardwired to the router

o Surge protector with Network Line Protection for CAH issued equipment

Anticipated hourly range: $21.50 per hour - $30.65 per hour

Bonus eligible: No

Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

• Medical, dental and vision coverage

• Paid time off plan

• Health savings account (HSA)

• 401k savings plan

• Access to wages before pay day with myFlexPay

• Flexible spending accounts (FSAs)

• Short- and long-term disability coverage

• Work-Life resources

• Paid parental leave

• Healthy lifestyle programs

Application window anticipated to close: 03/05/2025 *if interested in opportunity, please submit application as soon as possible. The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.

Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.

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