[Hiring] Lead Coordinator, Benefits Eligibility and Prior Authorization @Cardinal Health

Role Description

The Team Lead for Benefits Eligibility and Authorization is responsible for overseeing the daily operations of the Eligibility and Authorization team while maintaining hands-on involvement in verifying and maintaining insurance coverage and obtaining authorization across all patient accounts for all lines of business. This role combines individual contributor responsibilities with leadership duties, including:

• Problem-solving
• Staff support
• Training
• Presenting performance trends to the supervisor for performance management

The Team Lead guides team members through complex eligibility scenarios and provides expert guidance on prior authorizations for Medical Oncology, Radiation, and other Imaging therapies. This position communicates with patients and other departments regarding patient coverage, eligibility, and authorizations.

Responsibilities

• Provide daily workflow support and problem-solving assistance utilizing the SOP’s and reference documents for consistency and accuracy.
• Respond to team member questions regarding policies, procedures, complex cases, and system-related issues in a timely and thorough manner.
• Train and onboard new Eligibility and Authorization coordinators, ensuring they understand department processes, systems, and performance expectations.
• Monitor and review team performance and productivity metrics on a regular basis, identifying trends, opportunities for improvement, and coaching needs.
• Act as an escalation point for complex eligibility and authorization delays that require advanced problem-solving, ensuring prompt resolution.
• Coordinate and communicate information required or requested by other internal teams or site stakeholders within 24 hours.
• Oversee and provide expert guidance on prior authorizations for Medical Oncology, Radiation, Imaging therapies, and other high-risk denial medications.
• Maintain up-to-date knowledge of payer-specific requirements, including Medicaid, Medicare Advantage plans, and various commercial insurance plans.
• Demonstrate exceptional analytical and problem-solving abilities with a strong focus on accuracy and precision.
• Communicate effectively with all Revenue Cycle Management staff and clinical staff to ensure appropriate treatment can be provided.
• Maintain excellent customer service and kindness with all patients and staff.
• Maintain a high level of confidentiality for patients in accordance with HIPAA standards.
• Regular attendance and punctuality.
• Execute all functions of the role with positivity and team effort by accomplishing related results as needed.
• Effectively complete other duties and projects assigned.

Qualifications

• 4-5 years of experience, preferred
• Minimum four years of experience in a medical business office.
• Knowledge of medical terminology.
• Familiar with Urology, Chemotherapy, PET, and Radiation Billing.
• Experience with computerized billing software and interpreting EOBs.
• Working knowledge of ICD-10, CPT, HCPCS, and CPT coding.
• Knowledge of computer/telephony support, preferably in a healthcare environment.
• Strong customer service background, preferably in a healthcare environment.
• Competence with computer processing functions and other standard office equipment.
• Prior experience in Microsoft Office Suite.
• Ability to manage and prioritize multiple tasks.
• Ability to calmly and professionally resolve customer issues with diplomacy and tact.
• Ability to work independently with minimal supervision.
• Strong organizational skills.

Requirements

• Applies acquired job skills and company policies and procedures to complete standard tasks.
• Works on routine assignments that require basic problem resolution.
• Refers to policies and past practices for guidance.
• Receives general direction on standard work; receives detailed instruction on new assignments.
• Consults with supervisor or senior peers on complex and unusual problems.

Benefits

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