Cardinal Health
Pharma
Sr.Coordinator,IndividualizedCare(CaseManager)
“Sr. Coordinator, Individualized Care (Case Manager) at Cardinal Health. Skills: Customer service, Patient support, Benefit investigation, Prior Authorization, Appeals, Claims billing and Coding. 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”
What You'll Achieve.
Ensure accuracy and efficiency for the program; Ensure all items are resolved in a timely manner to the satisfaction of all parties
Industry & Context.
ability to problem solve; Resolve complex problems independently; May modify process to resolve situations; Resolve issues swiftly
Requires a dedicated, quiet, private, distraction free environment with access to high-speed internet, Responsible for providing high-speed internet, Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location, Download speed of 15Mbps, Upload speed of 5Mbps, Ping Rate Maximum of 30ms, Hardwired to the router, Surge protector with Network Line Protection for CAH issued equipment
What They're Looking For.
Must Have
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
Nice to Have
Previous customer service experience, High School diploma or equivalent, Patient Support Service experience, Clear knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers policies and guidelines for coverage, Knowledge of DME, MAC practices, Clear understanding of Medical, Supplemental, and pharmacy insurance benefit practices, Previous medical experience, Adaptable and Flexible, Self-Motivated and Dependable, ability to problem solve, Bilingual
What You'll Do.
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
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
Track any payer/plan issues and report any changes
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
and pharmacy to resolve issues swiftly
How You'll Work.
Team & Collaboration
Serve as a liaison between client sales force and applicable party; Responsible for reporting any payer issues by region with the appropriate team
Communication Scope
Conducts outbound correspondence; Resolve patient's questions; Notify patients, physicians, practitioners, and or clinics; Explain various programs to the patient; Ensure proper communication of the resolution; Mediate situations
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