Job Number: 20015449

Location: Statewide - New Jersey, NJ

Date Posted: 6-17-2017

Job Title: Senior Coordinator, Individualized Care (Case Manager)

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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.

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

  • Must demonstrate a superior willingness to help external and internal customers, white glove service is a must
  • 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
  • Must 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
  • Responsible for placing all outbound calls to ensure the process is complete
  • Assess patient’s financial ability to afford therapy and provide hand on guidance to appropriate financial assistance
  • Must follow through on all benefit investigation rejections, including Prior Authorizations, Appeals, etc. All avenues to obtain coverage for the product must be fully exhausted
  • Documentation must be clear and accurate and stored in the appropriate sections of the database
  • Must self-audit activities to ensure accuracy and efficiency for the program
  • Must track any payer/plan issues and report any changes, updates, or trends to management
  • Ability to 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
  • Serve as a liaison between client sales force and applicable party
  • Ability to effectively 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
  • Must self-audit activities to ensure accuracy and efficiency for the program
  • As needed conduct research associated with issues regarding the payer, physician’s office, and pharmacy to resolve issues swiftly

Qualifications

  • Previous customer service experience, preferred
  • High School diploma or equivalen, preferred
  • Demonstrated high level customer service
  • Experience conducting and documenting patient health insurance benefit investigations, prior authorizations, and appeals, preferred
  • Knowledge of Medicare, Medicaid and Commercially insured payer common practices and policies, preferred
  • Knowledge of the Health Insurance Market Place and the Affordable Care Act preferred
  • Knowledge of ICD9/ICD10 coding is preferred
  • Critical and creative thinking, preferred
  • Important to have a strong attention to detail

Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.


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