Derek Hensche Email & Phone Number

The Pharmacy Claims Audit team reviews prescription claims submitted by pharmacies to our Insurance Provider clients on a daily and retrospective basis, as well as in an Onsite capacity. We review for claims submission errors, potential FWA risks and concerns, and provide pharmacies with education to prevent these errors from occurring in the first place. The COVID-19 pandemic has brought on a new set of challenges, risks, and mandates for us to review and implement into our work life. We maintain up to date with the state specific, and federal guidance and monitor pharmacy activity related to COVID treatment and prevention.I currently lead a team of eight, including five Auditors, two Senior Auditors, and a Program Analyst. We are fully remote and communicate regularly via IM, phone, and video chat. Our team culture is a top priority along with a high level of delivery performance to meet our annual Client goals, performance guarantees, and service expectations.

Greater Minneapolis-St. Paul Area

In my role as the Supervisor of Operations for Government Membership, my primary accountability is over the Platinum Blue line of business. I have had the opportunity to lead a team of 30+ team members working with member enrollment and correspondence, as well as establishing and building upon business partner relationships. We have recently migrated this line of business to a new software platform which has presented new challenges and opportunities. We have since identified efficiencies in our processes and developed stronger collaboration across Operations.

In October of 2011, I was approached by the Apple Valley Medical Clinic administrator who described to me areas within the clinic that were need of improvement. I was given the opportunity to establish a business plan for a way to improve the telephone call, patient and provider messages, and incoming and outgoing fax messages. The plan that I established was approved by the administrator and the Board of Directors for implementation and just 4 months later on February 6th, 2012 the Information Hub went live. One month to the day later, I was also given the opportunity to manage the Patient Services department consisting of the Family Practice, Urgent Care, United Specialty Center reception desks, and the Pre-Registration, Insurance Verification, and Referrals departments.

Performed quality assurance for chronic health needs patients, specifically surrounding diabetic, cardiovascular health, depression, and asthma patients. Recorded, trended, and reported test results, education, and visit history to Minnesota Community Measurement. Worked closely with patients and health care providers to coordinate patient care and reach clinic goals of high percentage chronic patient population at blood pressure, LDL cholesterol, vision testing, and BMI goals. Performed pre-visit planning to aid provider and nursing staff in managing care plans for chronic health care needs patients.

Performed Appointment Desk scheduling, Family Practice and Urgent Care reception duties. Maintained accuracy in provider schedules with 15 independent practice providers requiring personalized guidelines. Promoted patient information safety in verifying patient demographic and insurance information at the time of check in at both the Family Practice and Urgent Care locations. Relayed messages to and from providers and patients to aid in the communication and coordination of health care needs. Collected and applied copays and patient balance payments to accounts.

Southern Metro Region, Minnesota

Developing and maintaining relationships with 13 retail locations. Manage events that promoted new activation sales and renewing existing contracts. Became one of the top sales reps in the the Southern Minneapolis region and listed as a top 10 performer on the national sales performance list.