Reimbursement Coordinator

at  Cardinal Health

WHAT INDIVIDUALIZED CARE CONTRIBUTES TO CARDINAL HEALTH

Clinical Operations is responsible for providing clinical specialties support and expertise in the areas of advice and consulting, research and patient care to internal business units and external customers.
Individualized Care provides care that is planned to meet the particular needs of an individual patient.

QUALIFICATIONS

• 3-6 years of experience, preferred
• High School Diploma, GED or equivalent work experience, 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 Medicare Administrative Contractor [MAC] practices; obtaining benefits and costs related to imaging and administration, preferred
• Clear understanding of Medical, Supplemental, and pharmacy insurance benefit practices, preferred
• 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 is preferred
• Adaptable and Flexible, preferred
• Self-Motivated and Dependable, preferred
• Strong ability to problem solve, preferred

QUALIFICATIONS

• 3-6 years of experience, preferred
• High School Diploma, GED or equivalent work experience, 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 Medicare Administrative Contractor [MAC] practices; obtaining benefits and costs related to imaging and administration, preferred
• Clear understanding of Medical, Supplemental, and pharmacy insurance benefit practices, preferred
• 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 is preferred
• Adaptable and Flexible, preferred
• Self-Motivated and Dependable, preferred
• Strong ability to problem solve, preferred

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
• Resolve patient’s questions and any representative for the patient’s concerns regarding status of their request for assistance
• Maintain accurate and detailed notations for every interaction using the appropriate database for the inquiry
• Make all outbound calls to patient and/or provider to discuss any missing information and/or benefit related information
• Assess patient’s financial ability to afford therapy and provide hand on guidance to appropriate financial assistance
• 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
• 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
• As needed conduct research associated with issues regarding the payer, physician’s office, and pharmacy to resolve issues swiftly

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
• Resolve patient’s questions and any representative for the patient’s concerns regarding status of their request for assistance
• Maintain accurate and detailed notations for every interaction using the appropriate database for the inquiry
• Make all outbound calls to patient and/or provider to discuss any missing information and/or benefit related information
• Assess patient’s financial ability to afford therapy and provide hand on guidance to appropriate financial assistance
• 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
• 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
• As needed conduct research associated with issues regarding the payer, physician’s office, and pharmacy to resolve issues swiftly