Specialty Pharmacy Representative I

Jefferson Health Plans

1d • 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
• 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

• AS/BS degree preferrered
• 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 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

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees