Reimbursement Coordinator (Patient Assistance and Support)

Cardinal Health

1d•Remote

About The Position

Cardinal Health Sonexus™ Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions—driving brand and patient markers of success. We’re continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Together, we can get life-changing therapies to patients who need them—faster.

Requirements

Ideally targeting individuals with a background in healthcare (such as medical assistant, working in medical claims/billing, pharmacy technician, clinician in a doctor's office, etc) or with insurance verification - highly preferred
Ideally targeting individuals with a high level of attention to detail, eagerness to learn, willingness to collaborate and communicate effectively
Ability to work in an environment that involves a high volume of varying tasks (must be willing to be flexible and wear a lot of different hats, without getting overwhelmed), required
Clear knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers' policies and guidelines for coverage, preferred
Knowledge of DME, MAC practices, preferred
Prior understanding of Medical, Supplemental, and pharmacy insurance benefit practices, preferred
Intermediate to advanced computer skills and proficiency in Microsoft Office including but not limited to Word, Outlook, and preferred Excel capabilities
Bilingual, preferred
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

Nice To Haves

background in healthcare (such as medical assistant, working in medical claims/billing, pharmacy technician, clinician in a doctor's office, etc) or with insurance verification
high level of attention to detail, eagerness to learn, willingness to collaborate and communicate effectively
Clear knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers' policies and guidelines for coverage
Knowledge of DME, MAC practices
Prior understanding of Medical, Supplemental, and pharmacy insurance benefit practices
Intermediate to advanced computer skills and proficiency in Microsoft Office including but not limited to Word, Outlook, and preferred Excel capabilities
Bilingual

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
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
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