Diplomat Specialty Pharmacy LLC

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Intake Referral Coordinator

at Diplomat Specialty Pharmacy LLC

Posted: 3/24/2020
Job Status: Full Time
Job Reference #: 9095c158-9a91-4e7e-8116-24a5fe578e58
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Job Description

About Diplomat Pharmacy:
Diplomat Pharmacy, Inc. is the nation’s largest independent provider of specialty pharmacy services- helping patients and providers in all 50 states.  We build solutions for today’s issues while laying the groundwork for tomorrow’s healthcare.  Rooted in specialty pharmacy, our brands harness innovation to create a healthier world. These include:

  • Diplomat Specialty Infusion Group: Our specialty infusion services deliver treatments nationwide, but a high-touch approach makes our care personal.
  • Diplomat Specialty Pharmacy: We help patients across the country face complex and often rare conditions.
  • CastiaRx: The industry’s leading specialty benefit manager, combining full-service pharmacy benefit manager capabilities with deep specialty expertise.
  • EnvoyHealth:  EnvoyHealth is a full-service healthcare solutions company using innovation and technology to help partners improve lives.

Headquartered in Flint, Michigan, we are more than 2,000 professionals working together nationwide to help patients realize health, happiness, and longer, fuller lives.

We are excited to announce that Diplomat, CastiaRx and EnvoyHealth are now part of the Optum family!

What We Offer:
Diplomat understands that high quality people are required to deliver high quality care and services to our patients and customers.  We combine a strong culture with meaningful work.  Being part of a patient’s care team is challenging, important, and rewarding. Diplomat needs strong, effective talent to lead our employees in a fast-paced and dynamic environment that fosters team work, learning, and career growth. At Diplomat, we encourage our employees to continuously learn through our internal Diplomat University classes as well as our Organizational Development team that offers leadership training and development. Listed below are some of the other benefits enjoyed by our team:

  • Matching 401K – 100% vested on the day you sign up!
  • Excellent Medical, Life, Dental & Vision Insurance
  • Short and long term disability Insurance
  • 9 Paid Holidays
  • Minimum of 3 weeks PTO
  • Award- winning wellness programs

 

Summary: The position of Intake Referral Coodinator assists the Admissions Team Lead with services and all issues related to referral procesing. The Intake Referral Coodinator is responsible for the accurate and complete processing (benefit verification through clearance) of speciality pharmacy and infusion therapy referrals from referral sources.

Education/Experience: High school diploma or GED required. Six months of relevant experience in the healthcare industry required. Specialty Infusion experienced preferred.

Certificates and Licenses:

Valid license, registration and/or certification, in good standing, to practice as a Pharmacy Technician as required by the Board of Pharmacy in the state employed preferred.

 

Duties and Responsibilities include the following. Other duties may be assigned.

  • Ensure that all referrals are complete, clear and within DSIG’s scope of service.
  • Verify insurance accurately and completely prior to passing the referral to the pharmacy staff.
  • Gather and exchange information to gain authorization for therapy requested and re-authorization as necessary which may include gathering patient-specific clinical data from referral sources
  • Coordinate with Sales and Advocates in order to facilitate records requests from referral sources.
  • Request and perform timely follow-up on authorizations for medical and pharmacy benefits
  • Calculate gross margins for therapies
  • Enter patient demographic information into the clinical system.
  • Communicate with other departments, including sales, regarding the status of referrals and documnentation requests.
  • Notify patients/families/referral sources regarding coverage and payment responsibilities as necessary.
  • Speak knowledgeably regarding reimbursement issues and which insurance companies DSIG has active contracts with.
  • Respond to inquiries from patients and referral sources via telephone, fax and electronic data interfaces.
  • Document in the patient’s clinical record progress notes, all requests and conversations for the purposes of seamless coordination of care.
  • Demonstrate professional etiquette and courtesy when interfacing with consumers/ customers.
  • Aid in the resolution of consumer/customer complaints by identifying problems and coordinating appropriate corrective action through attention to detail and taking the initiative to resolve issues before they become a problem.
  • Comply with and adheres to all regulatory compliance areas, policies and procedures and company “best practices”.
  • Insure that the patient database is complete for height, weight, current and past medical history, clinical laboratory results and concurrent medications (including over-the-counter and/or home remedy medications) as necessary.
  • Assist the pharmacist, nurse and patient with clinical and technical support.
  • Work with team of other pharmacists, pharmacy technicians, nurse manager and sales staff to ensure quality of care to all patients.

 

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Language Ability:

Ability to read, analyze, and interpret admissions process procedures. general business periodicals, professional journals, technical procedures. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

 Math Ability:

 Ability to comprehend and apply principles of basic math while analyzing data and generating reports.

 Reasoning Ability:

Ability to apply principles of logical thinking and decision makingto a wide range of intellectual and practical problems while under stress and respond quickly and accurately.

 

Computer Skills:

To perform this job successfully, an individual should have knowledge of Microsoft products.

 

Information Security Expectations:

While performing the duties of this job, the employee is required to abide by Diplomat’s information security policies, employee handbook and security and privacy regulatory requirements. Each employee is responsible for the secure and appropriate handling of Diplomat information, information received by customers, other companies and/or external parties.

Knowledge, Skills and Other Abilities:

  • Time management
  • Oral and written communication skills
  • Professionalism
  • Communication skills
  • Organization
  • Customer Service
  • Detailed
  • Multi-tasking skills
  • Ability to work well with various personalities and within a team
  • Medical terminology
  • Medical insurance

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.

 

Equal Employment Opportunity and Affirmative Action: Diplomat provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Diplomat complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.