Reimbursement Coordinator

$44,720 - $63,752/Yr

Cardinal Health - Boston, MA

Full-time

Boston, MA

Merchant Wholesalers, Nondurable Goods

About the position

The Sr. Coordinator of Individualized Care (Reimbursement Coordinator) plays a crucial role in facilitating patient access to therapy through comprehensive Reimbursement Support Services. This position is responsible for guiding patients through their therapy journey, which includes managing patient referrals, investigating health insurance benefits, and coordinating with various stakeholders such as insurance payers, specialty pharmacies, and healthcare providers to ensure timely coverage and dispensing of products.

Responsibilities

• Serve as the first point of contact for inbound calls, determining needs and handling inquiries accordingly.
• Create and complete accurate applications for enrollment with urgency.
• Thoroughly scrutinize forms and supporting documentation for completeness and accuracy.
• Conduct outbound correspondence to support patient and program needs.
• Provide detailed activity notes for Benefit Investigation processing.
• Collaborate with teammates to support patient population needs, transferring calls when necessary.
• Resolve patient inquiries and concerns regarding assistance requests.
• Update internal and external treatment plan statuses accurately.
• Maintain detailed notations for every interaction in the appropriate database.
• Self-audit intake activities for accuracy and efficiency.
• Make outbound calls to discuss missing information or benefit-related queries with patients and providers.
• Notify relevant parties of any financial responsibilities for services provided.
• Assess patients' financial ability to afford therapy and guide them to financial assistance options.
• Follow through on all benefit investigation rejections, including Prior Authorizations and Appeals.
• Track payer/plan issues and report changes or trends to management.
• Search for insurance options and explain programs to patients, helping them select the best coverage.
• Handle escalations based on region, ensuring timely communication of resolutions.
• Act as a liaison between client sales force and relevant parties.
• Mediate disagreements and facilitate positive outcomes.
• Manage multiple outstanding issues, ensuring timely resolution to all parties' satisfaction.
• Report payer issues by region to the appropriate team.
• Log and maintain reconciliation reports for Field requests to clients.
• Support team with call overflow and intake as needed.
• Conduct research on payer, physician's office, and pharmacy issues to resolve them swiftly.

Requirements

• Previous customer service experience is preferred.
• High School diploma or equivalent preferred.
• Patient Support Service experience is preferred.
• Clear knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers' policies and guidelines for coverage is preferred.
• Knowledge of DME, MAC practices is preferred.
• Clear understanding of Medical, Supplemental, and pharmacy insurance benefit practices is 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 Word, Outlook, and Excel capabilities.
• Previous medical experience is preferred.
• Bilingual is preferred.

Benefits

• Medical, dental and vision coverage
• Paid time off plan
• Health savings account (HSA)
• 401k savings plan
• Access to wages before payday with myFlexPay
• Flexible spending accounts (FSAs)
• Short- and long-term disability coverage
• Work-Life resources
• Paid parental leave
• Healthy lifestyle programs