Senior Coordinator (Case Manager), Access and Patient Support
Internal Number: 20124285
The Case Manager supports patient access to therapy through Reimbursement Support Services in accordance with the program business rules and HIPAA regulations. This position is responsible for guiding the patient through the various process steps of their patient journey to therapy. These steps include patient referral intake, investigating all patient health insurance benefits (pharmacy and medical benefits), and proactively following up with various partners including the insurance payers, specialty pharmacies, support organizations, and the patient/physician to facilitate coverage and delivery of product in a timely manner.
Investigate and resolve patient/physician inquiries and concerns in a timely manner
Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate
Proactive follow-up with various contacts to ensure patient access to therapy
Demonstrate superior customer support talents
Prioritize multiple, concurrent assignments and work with a sense of urgency
Must communicate clearly and effectively in both a written and verbal format
Must demonstrate a superior willingness to help external and internal customers
Working alongside teammates to best support the needs of the patient population or will transfer caller to appropriate team member (when applicable)
Maintain accurate and detailed notations for every interaction using the appropriate database for the inquiry
Must self-audit intake activities to ensure accuracy and efficiency for the program
Make outbound calls to patient and/or provider to discuss any missing information as applicable
Assess patient's financial ability to afford therapy and provide hand on guidance to appropriate financial assistance
Documentation must be clear and accurate and stored in the appropriate sections of the database
Must track any payer/plan issues and report any changes, updates, or trends to management
Handle escalations and ensure proper communication of the resolution within required timeframe agreed upon by the client
Ability to effectively mediate situations in which parties are in disagreement to 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
Support team with call overflow and intake when needed
Proactively following up with various partners including the insurance payers, specialty pharmacies, support organizations, and the patient/physician to facilitate coverage and delivery of product in a timely manner.
Handle customer escalated cases through investigation and case review
Contact customers to confirm approval/denials of coverage, co-pays, patient assistance programs, and verification of specialty pharmacy that will dispense their medication
Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate
Answer requests from doctors and/or patients checking on the status of the case
Maintain quality while providing an empathetic and supportive experience to the patients, doctors, and physician offices
Support manufacturer field team members as required on case updates
Works internally with team members regarding patients' cases
Ability to identify, document, and submit Adverse Events during customer contact or via received documentation
Conduct research associated with alternative funding or foundations to ensure the patient has the required information to receive product
Responsible for handling escalated cases and reporting to field-based representatives as needed
Conduct research as needed that is associated with escalations regarding patients, Physician's offices, and pharmacy to resolve matters quickly
All associated responsibilities of the Benefit Verification Specialist role as needed
Support team with work overflow when needed
3-6 years of experience
High School Diploma, GED or technical certification in related field or equivalent experience
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 8:00am-5:00pm CT, mandatory attendance is required.
This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our shift schedules during our normal business hours of Monday-Friday, 7:00am- 7:00pm CT.
Remote Details: You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following:
Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable. Download speed of 15Mbps (megabyte per second)
Upload speed of 5Mbps (megabyte per second)
Ping Rate Maximum of 30ms (milliseconds)
Hardwired to the router
Surge protector with Network Line Protection for CAH issued equipment
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
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.
Headquartered in Dublin, Ohio, Cardinal Health, Inc. (NYSE: CAH) is a distributor of pharmaceuticals, a global manufacturer and distributor of medical and laboratory products, and a provider of performance and data solutions for healthcare facilities.We are a crucial link between the clinical and operational sides of healthcare, delivering end-to-end solutions and data-driving insights that advance healthcare and improve lives every day. With deep partnerships, diverse perspectives and innovative digital solutions, we build connections across the continuum of care. With more than 50 years of experience, we seize the opportunity to address healthcare's most complicated challenges – now, and in the future.As a global, growing company, we’re able to offer rewarding careers that let you make a positive impact on our customers and communities.
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