Reimbursement Solutions Analyst

Cardinal Health • Oak Ridge, TN

6d • Onsite

About The Position

The primary purpose of this position is to oversee the evaluation and clearance procedures and treatment orders in the contracted outpatient hospital setting. The goal is to provide a detailed outline of clearance criteria as well as prior authorization and advocacy identification for procedures and medications scheduled to be given in the outpatient hospital setting.

Requirements

• 0 - 2 years of experience in related field preferred
• High level of attention to detail and a willingness to learn
• Strong analytical skills preferred
• Must be self-motivated and have the ability to understand and follow instructions
• Strong Microsoft Office skills (Excel, Word, Outlook)
• Strong written and verbal communication
• Able to work independently and solve problems on behalf of Cardinal and the customer
• Must be able to prioritize work to maximize job effectiveness
• Excellent interpersonal skills
• Strong ability to work under pressure and meet deadlines
• Strong telephone presence/etiquette
• Applies basic concepts, principles, and technical capabilities to perform routine tasks
• Works on projects of limited scope and complexity
• Follows established procedures to resolve readily identifiable technical problems
• Works under direct supervision and receives detailed instructions
• Develops competence by performing structured work assignments

Responsibilities

• Evaluate data input schedules from facilities to load work items
• Collaborate with facility EHR’s to gather data to support diagnosis and medical clearances
• Identify advocacy opportunities as it pertains to patient specific situations and insurance status
• Apply proper clearance criteria for medication regimens as insurance indicates
• Discuss medication options with pharmacy/physician and patient based on accessibility and availability (outpatient environment)
• Initiate and process applications for advocacy opportunities for qualifying patients
• Extensive contact with insurance companies to include speaking to representatives for benefit investigation as well as clinical clearance for prior authorization and medical necessity
• Extensive patient education/counseling to determine eligibility for Advocacy.
• Identify and resolve rejected applications, including accessing comparable drug regimen
• Refer patients that do not qualify for programs to other outside assistance. I.e. local charities
• Manage the drug recovery application process
• Assign appropriate billing level to each item processed in accordance with Reimbursement Solution guidelines
• Communicate with team lead to meet the needs of the assigned facility
• Maintain daily accounting activities and prior authorization documentation per the Reimbursement Solution procedures.
• Maintain security and confidentiality of patient information at all times.
• Demonstrates extensive knowledge and understanding of relevant clinical operations, products and services
• Influences customer decision to purchase new products and services
• Leads the post-sales assessment, design, implementation and monitoring of new products and services in multi-site and/or complex environments
• Develops, plans and manages customer training programs in multi-site and/or complex environments
• Serves as lead consultant and resource to internal and external customers in multi-site and/or complex environments
• Mentors internal staff regarding best demonstrated practices
• Significantly influences customer acceptance and utilization of new products and services in multi-site and/or complex environments
• Initiates discussion to obtain in-depth customer feedback for product and service improvement opportunities

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed