Reimbursement Coordinator

Cardinal Health, Inc.; Dallas (TX); On-site; USD 34,000 - 52,000; Full time

Job summary

Cardinal Health’s individualized care team near Dallas, Texas guides patients through enrollment, validates benefits, and resolves issues to help them access needed therapies.

The role handles high-volume inquiries, assists with eligibility checks, and supports with prior authorizations where needed, coordinating with payers and providers to secure timely coverage.

Qualifications

• 3–6 years of patient support experience preferred.
• High School Diploma, GED or equivalent work experience preferred.
• Knowledge of Medicare/Medicaid/Commercial payer policies.
• 1–2 years with prior authorization and appeals submissions.
• Bilingual preferred.

Responsibilities

• First point of contact on inbound calls and determines needs.
• Creates and completes accurate enrollment applications for enrollment with urgency.
• Scrutinizes forms and supporting documentation for missing information.
• Conducts outbound correspondence to support patient and program needs.
• Resolve patient questions and any representative concerns regarding status of assistance.
• Maintain accurate and detailed notations for every interaction in the database.
• Make outbound calls to discuss missing information or benefit related information.
• Assess patient’s financial ability to afford therapy and provide guidance to financial assistance.
• Provide detailed activity notes for Benefit Investigation processing.
• Work with teammates to support the needs of the patient population.
• Follow through on all benefit investigation rejections, including Prior Authorizations and Appeals.

Skills

Customer service

Payer knowledge

Problem solving

Communication skills

Data entry

Bilingual

Education

High School Diploma

GED

Tools

Microsoft Word

Outlook

Excel

Job description

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.

What Individualized Care contributes to Cardinal Health

Customer Service is responsible for establishing, maintaining and enhancing customer business through contract administration, customer orders, and problem resolution. Individualized Care provides care that is planned to meet the particular needs of an individual patient.

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.
• Maintain accurate and detailed notations for every interaction using the appropriate database for the inquiry.
• Make all outbound calls to patient and/or provider to discuss any missing information and/or benefit related information.
• Assess patient’s financial ability to afford therapy and provide hand on guidance to appropriate financial assistance.
• 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 .
• 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
• As needed conduct research associated with issues regarding the payer, physician’s office, and pharmacy to resolve issues swiftly

Qualifications

• 3-6 years of experience, preferred
• High School Diploma, GED, or equivalent work experience, preferred
• Patient Support Service experience, preferred
• Clear knowledge of Medicare (A, B, C, D), Medicaid & Commercial payer policies and guidelines for coverage, preferred
• Knowledge of Diagnostic Medical Expense and Medicare Administrative Contractor practices, preferred
• Clear understanding of Medical, Supplemental, and pharmacy insurance benefit practices, preferred
• 1-2 years experience with Prior Authorization and Appeal submissions, preferred
• 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
• Previous medical experience is preferred
• Adaptable and Flexible, preferred
• Self-Motivated and Dependable, preferred
• Strong ability to problem solve, preferred
• Bilingual is preferred

What is expected of you and others at this level

• 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

TRAINING AND WORK SCHEDULES

Your new hire training will take place 8:0…

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Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.