Pharmacy Tech- Specialty Pharm Rep- KOP

Jefferson Health; King of Prussia (Montgomery County); On-site; USD 40,000 - 55,000; Full time

Job summary

A leading healthcare provider is seeking a Pharmacy Tech-Specialty Pharm Rep to optimize patient outcomes through effective claim management and medication delivery. The role involves interacting with patients and healthcare providers, ensuring compliance with insurance processes, and maintaining accurate patient records. Candidates should possess strong customer service skills and a background in healthcare. Join a committed team dedicated to enhancing patient care in a dynamic environment.

Qualifications

• 3+ years in customer service; 1+ years in healthcare-related environment.
• Proficient in computers and Microsoft applications; typing speed of 35 wpm.

Responsibilities

• Assist patients with claim adjudication and refill activities.
• Schedule delivery of medications to ensure patient adherence.
• Act as a liaison between patients and insurance companies.

Skills

Customer Service

Problem Solving

Communication

Education

High School Diploma or GED

AS/BS degree

Tools

Microsoft Applications

Clinical Software

Job description

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Primary Responsibilities

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

Job Details

Primary Responsibilities

Same as above.

Job Description

ESSENTIAL FUNCTIONS:

• Adjudicate and review claims responses for reimbursement and profitability.
• Analyze claims messages to determine next steps such as Prior Authorization, Benefits Investigation, Step Therapy, Non-Formulary, Financial Assistance, etc.
• Schedule delivery of high dollar/specialty and maintenance medications to ensure patient adherence and compliance.
• Assess patient needs for clinical intervention based on refill responses or additional information.
• Identify barriers to care or non-compliance and escalate to the clinical support team when needed.
• Review and update patient charts for accuracy.
• Explain insurance coverage and copay responsibilities to patients.
• Screen and apply for financial assistance on behalf of patients.
• Print paperwork and fill prescriptions under pharmacist supervision.
• Track deliveries, ensure undamaged arrival, and reship if necessary.
• Participate in departmental Quality Assurance/Quality Improvement activities, contributing at least 2% of time.
• Interact with co-workers, visitors, and staff aligned with Jefferson’s iSCORE values.

Other Functions And Competencies

• Act as a liaison between patients and insurance companies, foundations, and manufacturers.
• Understand billing for commercial, Medicaid, and Medicare coverage.
• Skillfully listen, gather relevant information, and build trust with patients and providers.
• Respond compassionately to customers.
• Multi-task efficiently.
• Solve problems to ensure timely processing, ordering, and delivery of medications.
• Resolve complex customer conflicts professionally.
• Document and recognize trends.
• Possess knowledge of medical terminology, insurance language, HIPAA, and patient rights.
• Utilize software and technology to interact with customers via phone, web, or electronic means.
• Support customer inquiries and resolve issues promptly.
• Communicate effectively with customers.

Educational/Training Requirements

High School Diploma or GED preferred.

Certificates, Licenses, And Registration

AS/BS degree preferred; Certified Pharmacy Technician (CPhT) preferred.

Experience Requirements

3+ years in customer service; 1+ years in a healthcare-related environment such as a specialty pharmacy, hospital, or health insurance.

Additional Information

• Proficient in computers and Microsoft applications; typing speed of 35 wpm.
• Strong critical thinking and problem-solving skills.
• Experience with clinical software and Medicare billing preferred.
• Professional communication skills in writing and speaking.
• Flexibility and adaptability to departmental needs.
• Detail-oriented with excellent organizational skills.
• Ability to handle difficult conversations professionally.

Work Shift

Rotating (United States of America)

Worker Sub Type

Regular

Primary Location Address

3500 Horizon Drive, King of Prussia, PA

Jefferson Health is committed to providing equal opportunities and fostering a diverse workforce.