Senior Coordinator, Prior Authorization

What Customer Service Operations contributes to Cardinal Health

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.

Job Summary

The Senior Coordinator, Prior Authorization is responsible for obtaining, documenting, and tracking payer approvals for durable medical equipment (DME) orders, including diabetes devices and other clinically prescribed supply categories (e.g., ostomy, urological, wound care). This role submits prior authorization requests through payer portals or via fax, and conducts phone-based follow-ups with payers and provider offices to secure timely approvals. The Senior Coordinator proactively manages upcoming expirations to prevent order delays, meets daily productivity targets, and adheres to quality, compliance, and HIPAA standards.

Responsibilities

• Review assigned accounts to determine prior authorization requirements by payer and product category.

• Prepare and submit complete prior auth packets via payer portals, third-party platforms, or fax (including DWO/CMN, prescriptions, clinical notes, and other required documentation).

• Conduct phone-based follow-ups with payers (and provider offices when needed) to confirm receipt, resolve issues, and obtain approval or referral numbers.

• Log approvals accurately so orders can be released and shipped; correct rejected/pending decisions by addressing missing documentation or criteria.

• Monitor upcoming prior auth expirations and initiate re-authorization early to prevent delays on new and reorder supply shipments

• Prioritize work to give orders a "leg up" based on aging, SLA, and payer requirements.

• Capture all actions, decisions, and documentation in the appropriate systems with complete, audit-ready notes.

• Ensure secure handling of PHI and maintain full compliance with HIPAA, regulatory requirements, and company policy.

• Promptly report suspected non-compliance or policy violations and attend required Compliance/HIPAA trainings.

• Achieve daily throughput goals (accounts/records per day) across mixed work types (portal/web, fax, phone).

• Meet standardized quality metrics through accurate documentation and adherence to process; participate in supervisor live-monitoring, QA reviews, and 1:1 coaching.

• Share payer/process knowledge with teammates and support a strong team culture.

• Adapt to changes in payer criteria, portals, and internal workflows; offer feedback to improve allocation, templates, and documentation standards.

• Perform additional responsibilities or special projects as assigned.

Qualifications

• High School diploma, GED or equivalent work experience, preferred

• 3-6 years of experience in healthcare payer-facing work such as prior authorization, insurance verification, medical documentation, revenue cycle, or claims, preferred

• Proven ability to meet daily productivity targets and quality standards in a queue-based environment.

• Strong phone skills and professional communication with payers and provider offices; comfortable with sustained phone work.

• High attention to detail and accuracy when compiling documentation (DWO/CMN, prescriptions, clinical notes).

• Self-motivated with strong time management; able to pace independently without inbound-call cadence.

• Customer-centric mindset with a sense of urgency; capable of multitasking (working web/portal tasks while on calls).

• Working knowledge of HIPAA and secure handling of PHI.

• Experience with diabetes devices (CGMs, insulin pumps), and familiarity with ostomy, urological, and wound care product categories, preferred.

• Knowledge of payer criteria for DME prior authorization, including common documentation requirements and medical necessity standards, preferred

• Familiarity with payer portals and third-party platforms; experience with Grid or other work allocation tools, preferred.

• Exposure to ICD-10/HCPCS coding and basic authorization/claims terminology, preferred,

What is expected of you and others at this level

• Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments

• In-depth knowledge in technical or specialty area

• Applies advanced skills to resolve complex problems independently

• May modify process to resolve situations

• Works independently within established procedures; may receive general guidance on new assignments

• May provide general guidance or technical assistance to less experienced team members

Anticipated hourly range:  $16.75 per hour - $21.75 per hour

Bonus eligible:  No

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