The Benefit Investigation Specialist is responsible for supporting a patient during their drug reimbursement journey.  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.

Responsibilities

• Monitor system accounts for new Patient cases
• Conduct customers to confirm approval/denials of coverage, co-pays, patient assistance programs and verification of specialty pharmacy that will dispensing their medication
• Obtain and enter accurate benefit information to positively impact insurance processing and minimize rejections
• Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate
• Assess patients for eligibility for co-pay and financial assistance
• Answer requests from doctors and/or patients checking on status of case
• Maintain quality while providing an empathetic and supportive experience to the patients, doctors, and physician offices
• Resolve patient's questions and concerns regarding status of their request for assistance
• Enter detailed information into designated CRM while communicating with doctors or patients via multiple communication channels
• Steward patient accounts from initial contact through final approval/denial
• Process all patient applications in accordance to set policy, procedures, and PHI compliance
• Support manufacturer field team members as required on case updates
• Works internally with team members regarding patients' cases
• Ability to identify, document and submit Adverse Events during customer contact or via received documentation
• Conduct research associated with alternative funding or foundations to ensure patient has required information to receive product

Qualifications

• High School diploma or GED preferred
• Previous healthcare experience with insurance or in pharmaceutical industry, preferred
• Pharmacy benefits management experience preferred with specific knowledge of Medicare, Medicaid and commercially insured payer common practices and policies, preferred
• Previous prior authorization and appeals experience highly desired
• Knowledge of ICD coding, preferred
• Intermediate Microsoft skills with specific experience with Excel  
• Organized with the ability to prioritize multiple, concurrent assignments and work with a sense of urgency
• Exceptional communication skills both verbally and written
• Self-starter with demonstrated initiative, creativity, and a willingness to learn
• Bilingual, preferred

Desired Attributes:

• Willingness to learn
• Self-starter
• Attention to detail and high quality standards
• Adaptable
• Focused
• Organized
• Proactive
• Detailed
• Attentive
• Compassionate
• Empathetic

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

• TRAINING AND WORK SCHEDULES: Your new hire training will take place 8:00am-5:00pm CST, mandatory attendance is required. 

This position is full-time (40 hours/week).  Employees are required to have flexibility to work any of our shift schedules during our normal business hours of Monday-Friday, 7:00am- 7:00pm CST.

REMOTE DETAILS: You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following:

Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable.

• Download speed of 15Mbps (megabyte per second)
• Upload speed of 5Mbps (megabyte per second)
• Ping Rate Maximum of 30ms (milliseconds)
• Hardwired to the router
• Surge protector with Network Line Protection for CAH issued equipment

Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.