What Revenue Cycle Management (RCM) contributes to Cardinal Health
Practice Operations Management oversees the business and administrative operations of a medical practice.
Revenue Cycle Management manages a team focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue. The revenue cycle shadows the entire patient care journey and begins with patient appointment scheduling and ends when the patient?s account balance is zero.
Job Summary
The Authorization Denial Specialist is responsible for reviewing and resolving claim denials related to prior authorization and medical necessity. This role ensures accurate documentation, timely follow-up, and proper submission of appeals or corrected claims to reduce revenue loss. The specialist works closely with clinical, billing, and authorization teams to identify trends and prevent future denials.
Key Responsibilities
Review denied claims related to lack of prior authorization or medical necessity
Investigate root causes by verifying authorization status, payer policies, and documentation
Submit appeals, reconsiderations, or corrected claims as appropriate, including compiling medical records and supporting documentation
Work with clinical teams to obtain retro-authorizations or medical necessity letters when required
Experience with Complex Technical and Clinical Denials.
Communicate with payers to resolve denials and obtain updates on appeal status
Track, document, and follow up on all denial activity within the billing system
Monitor payer-specific authorization requirements and proactively identify changes
Assist in training or educating front-end teams on authorization best practices
Analyze denial trends and contribute to process improvement initiatives
Able to provide monthly denial trending to leadership.
Document all denial resolution activities in billing system
Monitor aged claims and ensure timely follow-up
Qualifications
Strong knowledge of insurance claim processing and denial management preferred.
Familiarity with Medicare, Medicaid, commercial insurance plans, and managed care preferred.
Proficiency in billing software (e.g. Athena, G4 Centricity, etc.) and Microsoft Office Suite.
Excellent verbal and written communication skills.
Ability to work independently and manage time effectively.
Detail-oriented with strong analytical and problem-solving skills
Medical, dental and vision coverage
Paid time off plan
Health savings account (HSA)
Application window anticipated to close: 05/05/2025 *if interested in opportunity, please submit application as soon as possible.
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate?s geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
Application window anticipated to close: 08/05/2025 *if interested in opportunity, please submit application as soon as possible.
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate?s geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
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.
Headquartered in Dublin, Ohio, Cardinal Health, Inc. (NYSE: CAH) is a distributor of pharmaceuticals, a global manufacturer and distributor of medical and laboratory products, and a provider of performance and data solutions for healthcare facilities.We are a crucial link between the clinical and operational sides of healthcare, delivering end-to-end solutions and data-driving insights that advance healthcare and improve lives every day. With deep partnerships, diverse perspectives and innovative digital solutions, we build connections across the continuum of care. With more than 50 years of experience, we seize the opportunity to address healthcare's most complicated challenges – now, and in the future.As a global, growing company, we’re able to offer rewarding careers that let you make a positive impact on our customers and communities.
