Pharmacy Tech- Specialty Pharmacy Rep- King of Prussia

Jefferson Health Plans • Renaissance Park, PA

6d • Onsite

About The Position

The Specialty Pharmacy Representative I works at Jefferson Specialty Pharmacy in King of Prussia, Pennsylvania. The role drives refill queues and supports patients, physicians, and pharmacists with claim adjudication and review, benefit investigations, financial assistance applications, refill and adherence activities, and other programs that support positive patient outcomes. The representative enters patient details—including name, date of birth, insurance information, allergies, and medication history—into therapy-specific patient assessment software. Under the direction of a patient care pharmacist, the representative also assists with filling and distributing prescriptions in accordance with applicable law.

The role reviews claims and insurance coverage, coordinates medication deliveries, assesses refill responses for potential clinical needs, identifies barriers to care or changes in therapy, and escalates issues to the clinical support team when appropriate. It also includes updating patient charts, screening for and applying for financial assistance, monitoring deliveries, and participating in departmental quality assurance and improvement activities.

Requirements

• At least 3 years of experience in a customer service role.
• At least 1 year of experience in a specialty pharmacy, hospital, health insurance company, benefits department, or related healthcare environment.
• Proficiency with computers and Microsoft applications.
• Typing speed of 35 words per minute.
• Critical-thinking and problem-solving skills, including the ability to make informed decisions and learn from past experiences.
• Ability to communicate professionally and efficiently, both verbally and in writing, with patients, physicians, payors, and clinical staff, in person and by phone.
• Flexibility to adapt to changing departmental needs, including assisting team members and adjusting assignments.
• Strong attention to detail and organizational skills, and the ability to learn quickly.
• Ability to adapt to a dynamic work environment.
• Ability to handle difficult conversations in a professional and caring manner.

Nice To Haves

• High school diploma or GED equivalent preferred.
• Associate's or bachelor's degree preferred.
• Certified Pharmacy Technician (CPhT) preferred.
• 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 and determine next steps for escalation, including prior authorization, benefits investigation, step therapy, non-formulary issues, and financial assistance.
• Schedule delivery of specialty, high-cost, and maintenance medications to support patient adherence and compliance with prescribed therapy and departmental guidelines.
• Assess whether patient responses to refill questions or other information indicate a need for clinical intervention.
• Identify barriers to care, non-compliance, and changes in therapy or dosing, and escalate them to the clinical support team when appropriate.
• Review patient charts to ensure information is accurate and up to date.
• Explain insurance coverage, copay responsibilities, and available financial resources to patients.
• Screen patients for financial assistance and submit applications on their behalf when applicable.
• Print paperwork and fill prescriptions under the supervision of a clinical pharmacist.
• Track and monitor deliveries, intervene when necessary, and arrange reshipment if medication does not arrive undamaged.
• Participate in departmental Quality Assurance/Quality Improvement activities for at least 2% of work time, with increased participation as needed.
• Interact with coworkers, visitors, and other staff in accordance with Jefferson's iSCORE values.

Benefits

• Medical insurance, including prescription coverage
• Supplemental insurance
• Dental insurance
• Vision insurance
• Life and AD&D insurance
• Short- and long-term disability
• Flexible spending accounts
• Retirement plans
• Tuition assistance
• Voluntary benefits, including access to group insurance rates and discounts
• Tuition discounts at Thomas Jefferson University after one year of full-time service or two years of part-time service
• Medical insurance, including prescription coverage, is available to all colleagues, including those working less than part-time

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED