Senior Representative, Customer Service - Authorizations

Cardinal Health is a company that specializes in providing outsourced services related to medical billing and reimbursement. They are seeking a Senior Representative, Customer Service – Authorizations to manage medical authorization requests for DME products, ensuring patients receive critical supplies while providing exceptional service to stakeholders.

Responsibilities:

• Completes and manages medical authorization requests for DME products, including CGM and pump supplies, using three primary submission methods: payer portals, phone calls, and fax
• Performs validation steps, including verifying documentation, confirming coverage, reviewing coding (ICD‑10, HCPCS), and ensuring completeness prior to submission
• Monitors and follows up on authorization status via payer portals, inbound/outbound calls, and fax replies
• Resolves authorization denials by coordinating with prescribers, payers, and internal partners; resubmits corrected or additional documentation when required
• Communicates professionally with patients, providers, medical groups, and payers to clarify requirements, request missing information, and provide status updates
• Collaborates with Order Fulfillment teams to ensure timely creation of work orders and product dispensing once authorization is approved
• Documents all activities accurately and meets established SLA timeframes, including 24‑hour turnaround expectations for assigned work
• Handles inbound and outbound calls (average 5–15 per day) regarding authorizations, status checks, and escalations
• Supports grievance or escalation handling by demonstrating ownership of outcomes and prioritizing patient impact
• Identifies workflow bottlenecks or payer‑specific issues and escalates as needed to leadership for process improvement opportunities
• Acts as a resource to peers, providing support aligned with the expectations of a senior‑level representative and assisting leadership with team coordination when needed

Requirements:

• 3-6 years of experience, preferred
• High School Diploma, GED or equivalent work experience, preferred
• Understanding of insurance authorization processes
• Basic knowledge of ICD‑10 and HCPCS coding
• Knowledge of insurance verification procedures and DME authorization workflows