Reimbursement Solutions Analyst
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About The Position
The Reimbursement Solutions Analyst position at Cardinal Health is a critical role within the Clinical Operations team, which is dedicated to supporting the timely and quality sale, installation, and monitoring of Cardinal Health products and services. This position is primarily focused on overseeing the evaluation and clearance procedures for treatment orders in the outpatient hospital setting. The analyst will be responsible for providing a detailed outline of clearance criteria, as well as identifying prior authorization and advocacy opportunities for procedures and medications scheduled in the outpatient environment. This role is essential for ensuring that patients receive the necessary approvals and support for their treatments, thereby enhancing patient management and care coordination. In this role, the analyst will evaluate data input schedules from various facilities to load work items efficiently. They will collaborate with facility electronic health records (EHRs) to gather pertinent data that supports diagnosis and medical clearances. A significant aspect of the job involves identifying advocacy opportunities related to patient-specific situations and their insurance status. The analyst will apply the appropriate clearance criteria for medication regimens as dictated by insurance policies and will engage in discussions regarding medication options with pharmacies, physicians, and patients based on accessibility and availability. The position requires extensive interaction with insurance companies, including speaking with representatives for benefit investigations and clinical clearances for prior authorization and medical necessity. The analyst will also provide patient education and counseling to determine eligibility for advocacy programs, manage the drug recovery application process, and ensure that all patient information is handled with the utmost security and confidentiality. Additionally, the analyst will maintain daily accounting activities and prior authorization documentation in accordance with Reimbursement Solution procedures, demonstrating a comprehensive understanding of relevant clinical operations, products, and services.
