Representative II, Customer Service - Insurance Verification

Cardinal Health

3d•$16 - $19

About The Position

What Customer Service Operations contributes to Cardinal Health Customer Service is responsible for establishing, maintaining and enhancing customer business through contract administration, customer orders, and problem resolution. Customer Service Operations is responsible for providing outsourced services to customers relating to medical billing, medical reimbursement, and/or other services by acting as a liaison in problem-solving, research and problem/dispute resolution

Requirements

High school diploma or equivalent (GED preferred.
Minimum of 2 years of experience in healthcare insurance verification or related role preferred.
Advanced knowledge of medical insurance terminology, policies, and procedures.
Skilled in using EHR systems, insurance verification software, and Microsoft Office applications.
Ability to remain in a stationary position most of the time (stand or sit).
Ability to occasionally lift and/or move up to 15 pounds.
Applies acquired job skills and company policies and procedures to complete standard tasks
Works on routine assignments that require basic problem resolution
Refers to policies and past practices for guidance
Receives general direction on standard work; receives detailed instruction on new assignments
Consults with supervisor or senior peers on complex and unusual problems

Responsibilities

Conducts in-depth insurance verifications for complex cases, such as multiple insurance coverages or specialized procedures.
Works under the guidance of the Insurance Verification Supervisor, utilizing their expertise to ensure accurate insurance coverage and billing information.
Researches and interprets insurance policies and benefits to determine coverage and eligibility for medical services.
Collaborates with insurance carriers and healthcare providers to address insurance-related inquiries and resolve issues.
Manages the pre-authorization process for high-level medical procedures and services, ensuring compliance with payer requirements.
Advocates for patients to obtain necessary authorizations and navigate insurance coverage challenges.
Evaluates authorization denials and appeals, providing documentation and support as needed.
Reviews and analyzes insurance claims for accuracy and completeness before submission.
Investigates and resolves complex insurance-related billing issues and claim rejections.
Provides guidance and training to junior insurance verification specialists on billing procedures and best practices.
Assists in conducting audits of insurance verification processes to ensure compliance with industry standards and regulations.
Identifies opportunities for process improvements and recommend solutions to enhance efficiency and accuracy.
Serves as a subject matter expert on insurance verification policies and procedures.
May perform any additional responsibilities or special projects as required.
May provide cross-functional support as business needs demand.
Duties and responsibilities may be subject to change based upon the needs of the department.