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.

Meets company quality standards.

Qualifications

HS, GED, bachelor's degree in business related field, or equivalent work experience preferred.

4+ years of relevant experience preferred.

Knowledge of insurance portals; familiarity with a variety of medical and / or insurance terms or practices.

Full knowledge all areas of collections specialization preferred.

Proficiency in Excel, basic math and business calculations.

Working knowledge of computer / data entry with the ability to learn new systems.

Advanced level of MS Office (Excel) proficiency preferred.

Any appropriate combination of relevant education, experience and / or certifications may be considered.

What is expected of you and others at this level

Applies comprehensive knowledge and understanding of concepts, principles, and technical capabilities to perform varied tasks and projects.

Develops innovative technical solutions to a wide range of difficult problems aligned with organizational objectives.

Independently completes work with general guidance; work is reviewed to ensure alignment with objectives.

May contribute to the development of policies and procedures.

Resolves highly escalated collections issues or concerns.

Cross-trained on all collections processes.

Demonstrates effective analytical skills using inductive and deductive reasoning to anticipate outcomes.

Proactively identifies challenges and applies a solution-oriented approach to problem solving.

Communicates in a friendly, professional, and effective manner; able to calmly present solutions in challenging situations.

Collaborates effectively with cross-functional teams; influences others through strong interpersonal skills.

Provides mentorship and training to less experienced colleagues as needed.

Manages and prioritizes multiple tasks / projects, works autonomously, and meets deadlines.

Works well in a team environment that promotes inclusiveness and open communication.

Demonstrates service orientation and aptitude to resolve insurance and / or patient matters.

Exhibits self-directed accountability and reliability.

Works on complex projects of large scope.

Benefits

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

• 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

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.