Advisor, Payer Rules & Credentialing

Customer Service Operations

Customer Service is responsible for establishing, maintaining and enhancing customer business through contract administration, customer orders, and problem resolution. Customer Service Operations is responsible for providing outsourced services to customers relating to medical billing, medical reimbursement, and / or other services by acting as a liaison in problem-solving, research and problem / dispute resolution.

Responsibilities :

• Analyzes and monitors payer trends, managed care contract compliance, contract and payer yield and indicators that reflect new opportunities for revenue or charge capture, operational improvements and increased reimbursement.
• Performs accurate and timely accounts receivable management.
• Analyzes accounts receivable transactions to ensure compliance with internal controls and accounting policies.
• Maintains and reconciles accounts receivable ledger and prepares management reports, including reports of delinquent accounts.
• Analyzes trends in bad debts and recommends improvements to accounts receivable policies and procedures.
• Works closely with all Revenue Cycle Departments and Managed Care.
• Coordinates with departments and insurance companies to correct errors as necessary.
• Documents and tracks all revenue cycle payer issues.
• Leads payer contract loads for underpayment recovery.
• Conducts analysis and outcome assessments on issue report.
• Communicates changes and prepares weekly reports that assist Revenue Cycle leadership.
• Maintains all documentation for the Payer Relations Team within Revenue Cycle to include Revenue Cycle Payer Relations emails via Resource Box in MS Outlook.
• Coordinates payer visits to learn about any portal enhancements, guidelines updates, contract updates.
• Assists with payer in-service training upon request.
• Audits proper use of account resolution from identification stage through resolution.
• Monitors reimbursement regulations.
• Maintains knowledge of current legislation concerning HMO appeals on both national and state level.
• Ensures appropriate coverage for compliance standards and revenue generation.
• Participates in management and other meetings as necessary.
• Attends all payer JOC (joint operating committee) meetings and represents the organization at the state level by attending statewide payer teleconference meetings with CMS, AA Homecare and HFMA.
• This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

Qualifications :

What is expected of you and others at this level :

Anticipated salary range : $67,500 - $96,300 per year.

Benefits : Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

Application window anticipated to close : 11 / 14 / 2025

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.