At Dohmen, we are committed to keeping our clients for life, ensuring no conflict of interest exists, achieving continuous innovation, and focusing on continuous improvement. Our behavior is guided by five simple values that define how we work and are the essence of what makes us successful:
Caring: We are empathetic and respectful. We ask “How can I help you?”
Committed: We are dedicated and persistent. We ask “How can I make it happen?”
Creative: We are inventive and imaginative. We ask “How can I do it better?”
Collaborative: We are cooperative and share our knowledge. We ask “How can we achieve success?”
Courageous: We’re willing to risk failure over inaction. We ask “How can I challenge myself”
The Patient Service Coordinator (PSC) is responsible for coordinating the Lifetime Care of the patient as well as being a resource for the physician and their staff. The PSC assists patients with navigating their healthcare benefit in an effort to minimize the financial burden of the lifetime therapy they require. From the submission of a prescription; to ongoing patient contact; with consistent follow –ups required to ensure compliance with therapy the PSC guides those involved with the patient through the entire evolution of care for the Life Time Therapy they require. This includes verifying benefits, obtaining prior authorizations, assisting with medical appeals and coordinating other financial assistance as needed. They will partner with internal departments to resolve customer issues as necessary
Acts as the primary point of contact for patients established on therapy; acts as a patient advocate and resource throughout the lifetime of care
Contacts patients monthly to coordinate care needed, including medication refills, creating patient orders and associated prescription entry for refills; Assists with any obstacles, concerns patient may have in order to ensure ongoing compliance with medication regimen
Completes supply orders and process patient returns as needed
Communicate with prescribers as needed, including requesting new prescriptions
Coordinate with nursing as needed for in home care
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Manage Fedex exceptions and notify patients as appropriate
Triage adverse events to appropriate clinical resource
Adjudicate PBM Claims; verify payment amount and resolve any nonpayment issues
Verify benefits monthly, prior to shipment
Ongoing benefit investigation and benefit explanation to patients as needed. Review next steps for insurance approvals or denials as appropriate.
Obtain and maintain prior authorizations, including obtaining needed clinical information necessary to submit authorization. Assist with appeals as needed.
Identify, educate and assist patients to secure appropriate financial assistance when requested
Review and send monthly patient statements for medical and PBM claims < 90 days and answer patient inquiries as needed
Handle inbound and outbound calls Bill secondary, patient balance, PBM Plus or other PBM insurance as needed
Coordinate wholesale distribution to an authorized facility as needed. Review wholesale facilities to ensure licensure is correct and up to date; update and maintain facility application
The above list reflects the general details necessary to describe the principle and essential functions of the position and shall not be construed as the only duties that may be assigned for the position.
An individual in this position must be able to successfully perform the essential duties and responsibilities listed above. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required.
High School Diploma or GED
1 years reimbursement experience required; including knowledge of pharmacy benefit and medical benefit insurance coverage
Strong communication, problem solving, and customer service skills
Ability to adapt and successfully handle unexpected situations
Current Missouri Pharmacy Technician registration or the ability to obtain
Computer proficiencies, including Microsoft office
Bachelor’s degree preferred
PHYSICAL AND MENTAL DEMANDS:
This is a largely sedentary role. While performing the duties of this job, the employee is regularly required to talk, hear, type and engage in repetitive motion.
The employee frequently is required to walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is occasionally required to stand or grasp. The employee is intermittently required to stoop or crouch; push or pull; or kneel.
The employee must occasionally lift and/or move up to 10 pounds and intermittently lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
This role requires mental alertness. The employee must regularly communicate both verbally and written; concentrate on tasks; and remember and observe details. The employee must frequently adjust to changes; handle stress and emotions; and think analytically.
The mental and physical requirements described here are representative of those that must be met by an individual to successfully perform the essential functions of this position.
This job operates in a professional office environment. This role routinely uses standard office equipment. The noise level in the work environment is usually moderate. The employee is not substantially exposed to environmental conditions.
The work environment characteristics described here are representative of those an individual encounters while performing the essential functions of this position.