Sr. Coordinator, Individualized Care (Case Manager) (Contractor Conversion)

Cardinal Health

6d•$21 - $31•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. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products. Together, we can get life-changing therapies to patients who need them—faster.

Requirements

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

Nice To Haves

Previous medical experience is preferred
Adaptable and Flexible, preferred
Self-Motivated and Dependable, preferred
Strong ability to problem solve, preferred
Bilingual is preferred

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
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
Mediate 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