Senior Coordinator, Individualized Care (Case Manager)

Job Description: Case Manager

What Individualized Care contributes to Cardinal Health

Delivering an exclusive model that fully integrates direct drug distribution to site-of-care with non-commercial pharmacy services, patient access support, and financial programs, Sonexus Health, a subsidiary of Cardinal Health, helps specialty pharmaceutical manufacturers have a greater connection to the customer experience and better control of product success. Personalized service and creative solutions executed through a flexible technology platform means providers are more confident in prescribing drugs, patients can more quickly obtain and complete therapy, and manufacturers can directly access more actionable insight than ever before. With all services centralized in our custom-designed facility outside of Dallas, Texas, Sonexus Health helps manufacturers rethink how far their products can go.

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

Accountabilities

  • 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
  • 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 o Will transfer caller to appropriate team member (when applicable)
  • 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
  • Ssearch 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
  • 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
  • Log and maintain a reconciliation report for all Field requests to send to client at their designated preferred date range
  • Support team with call overflow and intake when needed
  • As needed conduct research associated with issues regarding the payer, physician’s office, and pharmacy to resolve issues swiftly

Qualifications

  • Previous customer service experience is required
  • High School diploma or equivalent required
  • 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
  • Previous medical experience is preferred
  • Adaptable and Flexible, preferred
  • Self-Motivated and Dependable, preferred
  • Strong ability to problem solve, preferred
  • Bilingual is preferred