Sr. Coordinator, Individualized Care (Case Manager) (Contractor Conversion)

Cardinal Health Sonexus™ Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions—driving brand and patient markers of success. We’re continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products.

Together, we can get life-changing therapies to patients who need them—faster.

Responsibilities

•        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

•        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

•        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, physician’s office, and pharmacy to resolve issues swiftly

Qualifications

•        Previous customer service experience is preferred

•        High School diploma or equivalent preferred

•        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

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