[Hiring] Senior Coordinator, Individualized Care (Case Manager) @Cardinal Health

Role Description

• 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.
• 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 time frame agreed upon by the client.
• Serve as a liaison between client sales force and applicable party.
• Mediates situations in which parties are in disagreement 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.
• As needed conduct research associated with issues regarding the payer, physician’s office, and pharmacy to resolve issues swiftly.

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 if 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 is preferred.
• Adaptable and Flexible, preferred.
• Self-Motivated and Dependable, preferred.
• Strong ability to problem solve, preferred.
• Bilingual is preferred.

Requirements

• 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.

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, 8:00am-5:00pm 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:
• 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.
• Download speed of 15Mbps (megabyte per second).
• Upload speed of 5Mbps (megabyte per second).
• Ping Rate Maximum of 30ms (milliseconds).
• Hardwired to the router.
• Surge protector with Network Line Protection for CAH issued equipment.

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.

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