Specialty Pharmacy Representative

Thomas Jefferson University•Montgomery County, PA

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
AS/BS degree preferrered; 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

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.