Cardinal Health Senior Representative, Customer Service – Authorizations: Job Overview, Location, and Employment Details

The job title for this position is Senior Representative, Customer Service – Authorizations. This role is focused on managing medical authorization requests to ensure patients receive essential durable medical equipment (DME) products.

This position is located in Trenton, New Jersey. It is a full-time role within Cardinal Health’s Customer Service Operations.

The primary responsibilities of the Senior Representative include managing end-to-end medical authorization requests for DME products. This involves performing authorization submissions, managing status updates, and resolving denials across various payer channels.

The Senior Representative will be handling critical DME products, which include continuous glucose monitors (CGMs), insulin pump supplies, and other related equipment. These products are essential for patients requiring medical support.

Authorization requests are submitted using three primary methods: payer portals, phone calls, and fax. The Senior Representative must be proficient in utilizing these methods to ensure timely processing of requests.

Before submitting authorization requests, the Senior Representative must perform several validation steps. These include verifying documentation, confirming coverage, reviewing coding such as ICD-10 and HCPCS, and ensuring that all submissions are complete.

When authorization denials occur, the Senior Representative resolves these issues by coordinating with prescribers, payers, and internal partners. They are responsible for resubmitting corrected or additional documentation as required to facilitate approval.

Communication is crucial in this role as the Senior Representative must interact professionally with patients, providers, medical groups, and payers. They clarify requirements, request missing information, and provide status updates to ensure a smooth authorization process.

The Senior Representative is expected to collaborate with Order Fulfillment teams to ensure the timely creation of work orders and product dispensing once authorization is approved. This collaboration is essential for maintaining efficiency in the service delivery process.

The Senior Representative must document all activities accurately and adhere to established service level agreement (SLA) timeframes. This includes meeting a 24-hour timeframe for certain tasks to ensure compliance and efficiency.