Job Description
Senior Care Coordinator
Fully Remote • Remote Worker – N/A
Description
From Intake to Outcomes, CareMetx is dedicated to supporting the patient journey by providing hub services, innovative technology, and decision-making data to pharmaceutical, biotechnology, and medical device innovators.
Position Summary:
Under the general direction of the Operations Leadership, the Senior Care Coordinator will serve as the primary point of contact with the HCP, Patient, and client’s field reimbursement team leaders. The Senior Care Educator will use effective listening and communication skills to support patients, prescribers, and all clinic staff via phone and other support channels (email, SMS, etc.) to provide exquisite service and support. The Senior Care Educator will be responsible for speaking with providers and patients about Reimbursement Services including but not limited to Benefit Verifications, Prior Authorization, Appeals, Financial Support Services including but not limited to PAP, Copay support, independent foundation assistance, Adherence support, as well all other program services.
Care Coordinator will conduct monthly adherence calls and build relationships with patients to get ahead of any product access challenges and educate on the importance of maintaining therapy as prescribed by their provider. Care educators are responsible for maintaining an account enterprise view to ensure that provider and patient preferences for communication are met with the highest level of service.
The Care Coordinator will ensure open communication and resolution for problems and issues as they are identified and escalated by the field reimbursement team. The Senior Care Coordinator must have above average communication skills, a smile that can be heard behind the phone, demonstrate excellent organization and prioritization skills, and be adept at problem-solving issues as well as recognizing when to escalate issues. The Care Coordinator will be responsible for building a team environment with their applicable field counterparts, supporting open communication, performing root cause analysis of issues, tracking issues through to resolution, and ensuring program enhancements, process changes and program updates are shared back to the client’s field teams. This is a remote position with up to 10% travel required.
PRIMARY DUTIES AND RESPONSIBILITIES:
- Provide exquisite service to all stakeholders throughout their treatment journey.
- Be a subject matter expert on the program services and processes.
- Represent CareMetx and our clients by delivering excellent patient support that follows the CareMetx protocols and program materials.
- Provide patient and/or caregiver support, via telephone and other support channels, to address patient questions and concerns utilizing program specific approved talking points.
- Serve as a patient advocate and enhances the collaborative relationship between the payer, HCP, and patient.
- Act as a single point of contact and voice for all providers and patients.
- Document and maintain records of telephone interactions via a CRM platform.
- Recognize financial, medical, and legal risks based on data collected during patient interactions and follow appropriate procedures & protocols.
- Protect confidential information in accordance with policies.
- Manage a regional case load with a view to high level account management and customized communication with Key regional clinics and prescribers.
- Review and understand all patient insurance benefit information, to the degree authorized by the SOP of the program.
- Provide all necessary documentation required to expedite prior authorization requests including demographic, authorization/referrals, National Provider Identification (NPI) number and referring physicians.
- Provide assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications in a timely manner
- Collaborate, communicate, and integrate closely with the assigned field reimbursement team leaders.
- Establish and lead an agenda driven regular cadence of weekly, monthly, and quarterly meetings with assigned field reimbursement team leaders.
- Manage ad hoc/urgent escalations as needed; recognize impact and report major escalations and issues to CareMetx Operational leadership and Executive Sponsor as needed.
- Handle complex issues where analysis of situations or data requires an in-depth evaluation of variable factors.
- Participate as needed in client’s field team meetings to represent the operational program.
- Coordinate closely with internal operational program staff and share customer feedback, as applicable.
- Participate in quality monitoring process where calls and electronic records are reviewed to ensure patient receives the highest quality support possible.
- Provide exceptional customer service to internal and external customers, respond to customer requests in a timely and accurate manner.
- Comply with all appropriate program policies and procedures.
- Perform other related duties as assigned.
Qualifications
EXPERIENCE AND EDUCATIONAL REQUIREMENTS:
- 5 + years’ experience with specialty providers in support of reimbursement and/or reimbursement hubs or 5+ years’ experience with clinical and practice management.
- Prior experience as a COA – certified ophthalmic assistant, COT – certified ophthalmic technician, or COMT – certified ophthalmic medical technician is given preference.
- Bachelor degree or relevant Management in a Practice Management setting experience preferred.
MINIMUM SKILLS, KNOWLEDGE, AND ABILITY REQUIREMENTS:
- Excels in customer service
- Ability to communicate effectively both verbally and in writing
- Strong Computer application skills
- In depth knowledge of healthcare from a patient and provider perspective (clinical or reimbursement experience).
- Ability to build productive internal/external working relationships.
- Strong interpersonal skills and attention to detail.
- Ability to manage multiple tasks.
- Strong analytical skills.
- Excellent organizational skills; attention to detail.
- Adaptable, flexible, and demonstrates excellent problem-solving abilities.
- Ability to proficiently use Microsoft Excel, Outlook, and Word.
- Proven ability to appropriately escalate issues to management
- Ability to travel overnight (Up to 10% travel required) for conferences or client meetings
- Ability to schedule individual work-related travel (air, hotel, rental car as needed).
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit. The employee must also occasionally lift and/or move up to 10 pounds.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
Schedule:
- Must be flexible on schedule and hours
- Must be willing to work weekends if required to meet company demands
- Some travel may be required