Sr. Coordinator, Individualized Care; Case Manager

Position: Sr. Coordinator, Individualized Care (Case Manager)
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.

** _What Individualized Care contributes to Cardinal Health_*
* Clinical Operations is responsible for providing clinical specialties support and expertise in the areas of advice and consulting, research and patient care to internal business units and external customers.

Individualized Care provides care that is planned to meet the particular needs of an individual patient.

** _Key Responsibilities _*
* + Provide end to end claims support including submission guidance, tracking, resolution, billing and coding support, and reimbursement assistance.

+ Serve as a primary provider contact, validating claim requirements, supporting clean resubmissions, and driving timely reimbursement outcomes.

+ Review denied claims, identify the root cause of denial, and provide clear correction guidance for provider resubmission.

+ Track status and follow up with payers as required, maintaining a consistent cadence to drive resolution.

+ Support prior authorization requirements and assist with appeals processes when coverage is denied, guiding providers on payer requirements and next steps.

+ Support workflows that provide reimbursement to providers via electronic fund transfer when immunizations are not covered and all attempts to secure a paid claim have been exhausted, in alignment with program business rules.

+ Process enrollments received through digital and assisted channels, including portal intake and IVR or live agent support, and maintain accurate case documentation and communications in CRM.

+ Provide world class service across inbound and outbound interactions with provider offices and other stakeholders, striving for efficient resolution and professional de-escalation when needed.

+ Maintain complete, compliant documentation, ensuring accurate capture of insurance, coverage approvals, ongoing coverage requirements, and interaction notes.

+ Identify and report Adverse Events

+ Collaborate with internal and external partners, using root cause analysis to resolve access barriers and sharing learnings with the team to improve processes and outcomes.

+ Contribute to program readiness by supporting work instructions, SOP adherence, and training adoption as requirements evolve.

+ Strong provider facing communication, problem solving, and documentation discipline.

+ Ability to manage time sensitive work, prioritize effectively, and drive follow through to resolution.

+ Comfort with data driven workflows and CRM based case management.

+ Claims investigation completion timeliness and quality.

+ Missing information outreach and collection timeliness.

+ Provider relay results timeliness following claim investigation completion.

+ Customer service quality monitoring scores and customer satisfaction performance.  ​​

** _Required Qualifications _*
* + 3-6 years of experience, preferred

+ High School Diploma, GED or equivalent work experience, preferred

+ Demonstrated experience in reimbursement support services, benefit investigation, claims, prior authorization, appeals, or similar healthcare access functions.

+ Ability to work in a changing environment andmaintainresiliency as systems and requirements evolve.

** _Preferred Qualifications _*
* + Experience guiding providers through claims correction and resubmission processes.

+ Experience working with medical and pharmacy benefit payers and navigating payer specific rules.

+ Experience supporting immunization, buy and bill, or medical benefit claim workflows.

+ Prior hub or patient support services experience…