Pharmacy Tech, Specialty Pharmacy Rep- KOP

Jefferson Health Plans•Park, KS

7d•Onsite

About The Position

The Specialty Pharmacy Representative I drives our refill queues and assists patients, physicians and pharmacists in the completion of: claim adjudication/review, benefit investigations, financial assistance applications, refill/adherence activities, and other programs that drive optimal outcomes for Jefferson Specialty Pharmacy patients. Responsibilities include entering the patient information; name, date of birth, insurance information, allergies and medication history into our therapy-specific patient assessment software. Assist with the filling and distribution of prescriptions, under the direction of a patient care pharmacist, in accordance with the law.

Requirements

High School Diploma or GED equivalent preferred
AS/BS degree preferred
Certified Pharmacy Technician (CPhT) preferred
3+ years experience in customer service role
1+ years experience in a specialty pharmacy, hospital, health insurance company, benefits department or other related healthcare environment.
Proficient in the use of computers and Microsoft applications.
Type 35 wpm.
Critical Thinking skills to solve problems and make informed thought out decisions; ability to learn from and lean on past experiences
Ability to communicate professionally and efficiently in both written and verbal format with patients, physicians, payors and clinical staff in-person and on the phone.
Flexibility to adapt to changes in the departmental needs including but not limited to: offering assistance to other team members, adjusting assignments, etc.
Detailed orientated with excellent organization skills, ability to learn quickly
Ability to adapt in a dynamic work environment
Demonstrated ability to handle difficult conversations in a professional and caring manner

Nice To Haves

Experience with clinical software systems
Specialty Medications and Medicare billing is highly preferred.

Responsibilities

Adjudicate and review claims responses for reimbursement and profitability
Analyze claims messages to determine next steps for order escalation as needed: Prior Authorization, Benefits Investigation, Step Therapy, Non-Formulary, Financial Assistance, etc
Schedule delivery of high dollar/specialty medications as well as other maintenance medications to maintain patient adherence and compliance to prescribed therapy according to departmental policy and guidelines
Assess patient need for clinical intervention based on how they answer the refill questions or any information they may provide unrelated to the refill assessment
Identify any barriers to care, non-compliance, changes in therapy/dosing and escalate to the clinical support team when appropriate
Review patient chart to ensure all information is accurate and up to date
Explain insurance coverage to patients as it relates to their copay responsibility and financial resources available to them
Screen patients for financial assistance and apply on their behalf where applicable
Print paperwork and fill prescriptions under the supervision of a clinical pharmacist
Track and monitor deliveries to ensure medication arrives to patient undamaged; intervene where necessary to reship delivery
Contributes to departmental Quality Assurance/Quality Improvement activities. Expected participation no less than 2% of time – increased participation based on need/project.
Interacts with co-workers, visitors, and other staff consistent with the iSCORE values of Jefferson.
Act as a liaison between the patient and their insurance company, foundations, and manufacturers
Knowledge of commercial, Medicaid, and Medicare billing and understanding program requirements for all types of coverage
Demonstrated ability to listen skillfully, collect relevant information, and build relationship and trust with patients and providers
Respond to customers in a compassionate manner
Multi-task between several issues at one time
Problem solve to serve patients and ensure their medications are processed, ordered and delivered in a timely manner.
Independently resolves complex customer conflicts including but not limited to: damaged/lost products, order placement, and outstanding balances and invoices
Proactively document and recognize cause and effect trends
Knowledge and understanding of the following: medical terminology and medical terminology used by insurance, the Health Insurance Portability and Accountability Act, and of principles and practices associated with the rights and responsibilities of patients and caregivers.
Knowledge of and ability to utilize software, technologies and applications to interact with customers via a telephone, web or other electronic means.
Knowledge of the major responsibilities, accountabilities, and overall organization of the customer support function or department, ability to properly support customer inquiries and bring problems to a timely resolution.
Knowledge of and ability to utilize practices, tools, and techniques for communicating with a customer

Benefits

medical (including prescription)
supplemental insurance
dental
vision
life and AD&D insurance
short- and long-term disability
flexible spending accounts
retirement plans
tuition assistance
voluntary benefits
tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.