Patient Care Coordinator

Job Title : Patient Care Coordinator

Location : Remote

Contract : 3 - 6 Months Contract

Under the general supervision of an Operations Manager, they are considered masters of our services, including but not limited to reimbursement activities, claim submission, claim status, collection activity, appeals, patient assistance, and copay assistance. On a day-to-day basis, they may be in contact with various customers of our services, including but not limited to patients, providers, caregivers, and client brand teams.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Master all standard and advanced services and perform them as needed for the benefit of our patients, including but not limited to:
• Billing and coding support
• Claims assistance, tracking, and submission
• Prior authorization assistance and tracking
• Coordination of benefits
• Benefit verification result calls
• Welcome calls
• Advanced alternate coverage research
• Appeals/Denials
• Inbound phone queue/general program inquiries
• Determination for support programs (Copay, PAP, Medicaid, etc.)
• Pharmacy triage and coordination
• Order processing for wholesale orders
• Other follow-up activities (missing info, prior authorization, etc.)
• Intakes and reports adverse events as directed
• Non-clinical adherence services
• Engage with manufacturer representatives around items like payer profiles, reimbursement trends, issues with specific offices, etc.
• Coordinate services with field reimbursement teams and sales representatives.
• Provide exceptional customer service to internal and external customers; resolve any customer requests in a timely and accurate manner; escalate complaints as needed.
• Independently analyze, report, resolve, and communicate any reimbursement trends/delays (e.g., billing denials, claim denials, pricing errors, payments, etc.).
• Process any necessary correspondence.
• Coordinate with internal and external service providers to ensure services are performed in accordance with program policy and within expected service level agreements (SLA).
• Provide training and support to internal associates.
• Field questions from program representatives and specialists.
• Handle initial customer escalations.
• Verify that transactions and processes comply with organizational and departmental policies and procedures; suggest changes and solutions as appropriate.
• Independently and effectively resolve complex accounts with minimal supervision.
• Maintain confidentiality regarding all patient-sensitive information.
• Work on complex issues where analysis of situations or data requires in-depth evaluation of variable factors. Exercise judgment in selecting methods, techniques, and evaluation criteria for obtaining results. Network with key contacts outside one's area of expertise.
• Act independently to determine methods and procedures for new or special assignments.
• Perform related duties and special projects as assigned.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

• High school diploma or GED required.
• Broad training in fields such as business administration, accounting, computer science, medical billing and coding, customer service, or similar vocations, generally obtained through completion of a two-year associate’s degree program, technical vocational training, or an equivalent combination of experience and education.
• Five (5) or more years of directly related and progressively responsible experience required.
• A two-year degree can be used in lieu of 2 years of the experience requirement, and a four-year degree in lieu of 4 years of experience.
• A four-year degree is preferred.

MINIMUM SKILLS, KNOWLEDGE, AND ABILITY REQUIREMENTS:

• Ability to communicate effectively, both orally and in writing.
• Ability to build productive internal/external working relationships.
• Advanced interpersonal skills.
• Strong mathematical skills.
• Basic analytical skills.
• Advanced organizational skills and attention to detail.
• Extensive knowledge of pharmacy operations and medical claims.
• Excellent use of medical industry vernacular.
• General knowledge of health care billing required; advanced knowledge preferred.
• Advanced proficiency in Microsoft Excel, Outlook, and Word.
• Developing professional expertise; applies company policies and procedures to resolve a variety of issues.

If you are interested, please apply & reach out to Recruiter- Gaurav Yadav

Call- (945) 215-0159

Email- [email protected]

Dexian is a leading provider of staffing, IT, and workforce solutions with over 12,000 employees and 70 locations worldwide. As one of the largest IT staffing companies and the 2nd largest minority-owned staffing company in the U.S., Dexian was formed in 2023 through the merger of DISYS and Signature Consultants. Combining the best elements of its core companies, Dexian's platform connects talent, technology, and organizations to produce game-changing results that help everyone achieve their ambitions and goals.

Dexian's brands include Dexian DISYS, Dexian Signature Consultants, Dexian Government Solutions, Dexian Talent Development and Dexian IT Solutions. Visit https://dexian.com/ to learn more.

Dexian is an Equal Opportunity Employer that recruits and hires qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status