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, 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.
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
Part I (Intake): The Case manager (CM) is responsible for handling all incoming calls (all regions) to the assigned program. This CM must also process the new enrollment application received for any new or existing patient within that region. The CM must also provide accurate and timely follow-through on all call tasks and commitments and ensure that communications are clear, proper action is taken, and all internal processes are followed according to the company policies and program specific work instructions as outlined. The CM must also problem solve, think outside of the box, and work alongside team members to best support this program in relation to intake and inbound communications. It is imperative that the Case Manager providers each caller with white glove service in every aspect of their role.
Essential Duties and Responsibilities: 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. 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
Part II (Benefit Coordination): The Case manager is also a dedicated subject matter expert for their assigned region. This Case manager is solely responsible for relaying all benefit information, PA, Appeal, or Pre-Determination to the patient and/or provider. The CM must also problem solve, think outside of the box, and work alongside team members to best support this program as it relates to benefit investigation support. It is imperative that the Case Manager providers each caller with white glove service in every aspect of their role.
Essential Duties and Responsibilities:
Must demonstrate a superior willingness to help external and internal customers, white glove service is a must. 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.
Part III (Solutions Specialist for Field): The third part of Case management is acting as a dedicated single point of contact based upon region and client sales force. This position requires problem solving capabilities and analytical skills, to assist with escalated issues. This individual is responsible for providing oversight assurance to the client sales force associated with the client and program. Daily workflow to include: Research on client concerns and issues related to specified accounts, providers, payers, and general operations based on region.
Essential Duties and Responsibilities:
Must demonstrate a superior willingness to help external and internal customers, white glove service is a must. 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.
- 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
- Previous customer service experience is required
- College diploma or equivalent Mandatory
- Demonstrated High level customer service
- Patient Support Service experience
- Clear knowledge of Medicare, Medicaid & Commercial payers policies and guidelines for coverage is required
- Must have clear understanding of Medicare plans (A, B, C, D...)
- Knowledge of DME, MAC practices if preferred
- Must have clear understanding of Medical, Supplemental, and pharmacy insurance benefit practices
- Must have 3-5 years of Pharmacy and/or Medical Claims billing and Coding work experience.
- Must have 3-5 years’ experience with Prior Authorization and Appeal submissions
- Demonstrated 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
This position will include a $500.00 sign on bonus and a one year retention bonus.
Must be available 7:00am -7:00pm
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.