Dohmen Life Science Services

  • Lead Patient Service Coordinator

    Job Locations US-MO-Chesterfield
    Job ID
    2018-2107
    # of Openings
    1
    Category
    Patient & Customer Support
  • Overview

    OUR CULTURE:

    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 POSITION:

    The Lead Patient Service Coordinator is responsible for ensuring quality patient care by serving as a resource for Patient Service Coordinators (PSCs), supporting the PSCs with on the job training and assisting the team with patient and physician escalations.  The Lead will work closely with the supervisory team to ensure that program goals and key performance indicators are met, will conduct quality audits, participate in special projects, and other duties as assigned.

     

    Critical RESPONSIBILITIES:

    • First line resource for the PSC regarding complex issues and customer escalations.
    • Serve as the designated On the Job Trainer for both new and existing team members
    • Complete quality audits as assigned
    • Assist with monitoring program metrics to ensure team tasks are completed per contractual obligations

     

    essential duties and responsibilites:

    • Act as a backup to PSC as needed
    • May have regular patient assignments.
    • Interface with client as needed
    • Assist with identifying program enhancements and improvements
    • Communicate with prescribers as needed, including requesting new prescriptions
    • Coordinate with nursing as needed for in home care
    • 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
    • Serve as back up for Supervisor as needed
    • All other duties as assigned

    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.

     

    MINIMUM qualifications:

    The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required.

     

    • High School Diploma or GED required
    • 4 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
    • Ability to handle challenging customers in a professional manner
    • Demonstrated leadership skills with desire to continue to develop
    • Current Missouri Pharmacy Technician registration or the ability to obtain
    • Computer proficiencies, including Microsoft office

     

    Preferred qualifications:

     

    • Bachelor’s degree
    • 1 year experience with DLSS processes and systems

     

    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.

     

    Working ENVIRONMENT:

    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.

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