Dedicated Case Coordinator North Central

Why Patients Need You The Inflammation and Immunology Dedicated Case Coordinator (DCC) is a non-promotional, field-based role that supports patients’ access to PDPA and VFM products when prescribed by a licensed healthcare provider. The DCC owns the continual management and progression of the patient journey — from HUB enrollment through post-fill follow-up — working directly with patients, providers, payers, HUB partners, and third-party vendors. It is a dual patient- and HCP-facing role spanning a patient journey, and the colleague in this role carries 100% ownership of every case in their assigned geography. What You Will Achieve The DCC is a subject-matter expert on reimbursement, access, and coverage issues that can educate patients/caregivers and healthcare providers on matters relating to reimbursement, access, and coverage. The DCC will serve as the primary point of contact for patients/caregivers and healthcare providers regarding the status of their request for reimbursement support and access assistance and will also provide updates to patients/caregivers and healthcare providers on their status as appropriate. The DCC holds end-to-end case ownership: benefits investigation and verification, prior authorization and appeals support, appointment and baseline assessment coordination, Interim Care and voucher administration, copay support, prescription triage, and scheduled post-fill follow-up. How You Will Achieve It Case Ownership and the Patient Journey Own 100% of assigned cases and drive the continual management and progression of the patient journey, from HUB enrollment through post-fill follow-up Be the central point-of-contact for patients/caregivers and HCP providers regarding the status of their request for reimbursement and access support related to a patient case. Answer questions from patients/caregivers relating to access and coverage Maintain a clear understanding of the patient access journey and requirements at each stage of the process, as well as the role played by patients/caregivers and HCP providers in the process Support access with HCPs and opted-in patients/caregivers who have been prescribed a PDPA OR VFM product Benefits Investigation and Financial Navigation Conduct the Summary of Benefits (SOB) discussion required for every HUB-enrolled patient, reviewing both the product benefit structure, any associated cost and the baseline appointments for VFM Obtain all missing information on the Patient Enrollment Form (PEF) and verify the testing, voucher, and Interim Care options selected by the HCP office Walk the patient through out-of-pocket cost, deductibles, copay options, and the reimbursement program, including the impact of maximizers and accumulators Verify coverage for the product and for required baseline tests across both PBM and major medical insurance for VFM Oversee the entire prior authorization process, including submission and verification with both the patient and the provider Conduct benefit investigation and verification (BI/BV) calls directly with payers and patients for patients with 3rd party restrictions Confirm and communicate product coverage, cost, prior authorization and appeal requirements, Interim Care program PA and Appeal deadlines, and baseline assessment tests to HCP and patient Appointment and Assessment Coordination Schedule, reschedule and confirm patient appointments in coordination with the patient, the provider, and the vendor Secure the appropriate confirmation communication back from the provider (CFT) Coordinate compliantly with IQVIA/MDX on patient assessment tests — confirm tests are completed and reschedule where needed Program and Copay Administration Once IC is approved, manage all Interim Care (IC) program administrative requirements and deadlines with the provider and the patient, including Extended Interim Care programs Confirm voucher need and eligibility with the provider and patient, and triage the voucher for shipment to the patient