Pharmacy Tech- Specialty Pharm Rep- KOP

Thomas Jefferson University & Jefferson Health; Lansdale, Buffalo (Montgomery County, NY); On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a Specialty Pharmacy Representative I to join their team. In this dynamic role, you will manage refill queues, support patients and healthcare providers, and ensure compliance with medication delivery. Your expertise in customer service, critical thinking, and communication will be key in navigating complex insurance processes and providing compassionate care. This position offers a unique opportunity to make a significant impact on patient outcomes while working in a collaborative environment. If you are passionate about healthcare and eager to contribute to a team dedicated to excellence, this role is for you.

Qualifications

• 3+ years of customer service experience, preferably in healthcare.
• Knowledge of insurance practices and HIPAA regulations.

Responsibilities

• Manage refill queues and support patients with claim adjudication.
• Analyze claims messages and schedule medication deliveries.

Skills

Customer Service

Communication Skills

Critical Thinking

Problem-Solving

Medical Terminology

Insurance Practices

Education

High School Diploma or GED

AS/BS degree

Certified Pharmacy Technician (CPhT)

Tools

Microsoft Office

Clinical Software

Job description

Job Details

PRIMARY RESPONSIBILITIES: The Specialty Pharmacy Representative I manages refill queues and supports patients, physicians, and pharmacists by handling claim adjudication/review, benefit investigations, financial assistance applications, refill/adherence activities, and other programs aimed at achieving optimal 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 assessment software. Assist with filling and distributing prescriptions under the supervision of a patient care pharmacist, in accordance with legal requirements.

Job Description

ESSENTIAL FUNCTIONS:

1. Adjudicate and review claims responses to ensure reimbursement and profitability.
2. Analyze claims messages to determine necessary next steps, including escalation for Prior Authorization, Benefits Investigation, Step Therapy, Non-Formulary, Financial Assistance, etc.
3. Schedule delivery of high-cost/specialty and maintenance medications to ensure patient adherence and compliance, following departmental policies.
4. Assess patient needs for clinical intervention based on refill responses and other provided information.
5. Identify barriers to care or non-compliance, and escalate to the clinical support team when appropriate.
6. Review and verify accuracy of patient charts and information.
7. Explain insurance coverage details, copay responsibilities, and available financial resources to patients.
8. Screen patients for financial assistance and assist with applications where applicable.
9. Print paperwork and fill prescriptions under pharmacist supervision.
10. Monitor deliveries to ensure medications arrive undamaged; reship as necessary.
11. Participate in departmental Quality Assurance/Quality Improvement activities, dedicating at least 2% of time, with increased participation as needed.
12. Engage with co-workers, visitors, and staff in alignment with Jefferson’s iSCORE values.

OTHER FUNCTIONS AND COMPETENCIES:

• Serve as a liaison between patients, insurance companies, foundations, and manufacturers.
• Understand billing procedures for commercial, Medicaid, and Medicare coverage.
• Excellent listening skills, ability to build trust with patients and providers.
• Respond compassionately to customer inquiries.
• Manage multiple issues concurrently.
• Resolve complex customer conflicts professionally.
• Document and analyze trends proactively.
• Knowledge of medical terminology, insurance practices, HIPAA, and patient rights.
• Proficient in using software, technologies, and applications for customer interaction.
• Support customer inquiries effectively and resolve issues promptly.

EDUCATIONAL/TRAINING REQUIREMENTS:

High School Diploma or GED preferred. AS/BS degree and Certified Pharmacy Technician (CPhT) certification preferred.

EXPERIENCE REQUIREMENTS:

Minimum 3 years in customer service; at least 1 year in a healthcare environment such as a specialty pharmacy, hospital, or health insurance.

ADDITIONAL INFORMATION:

• Proficient in computers and Microsoft Office; typing speed of 35 wpm.
• Strong critical thinking and problem-solving skills.
• Experience with clinical software and Medicare billing preferred.
• Excellent communication skills, both written and verbal.
• Flexible and adaptable to departmental needs.
• Highly organized with quick learning ability.
• Capable of handling difficult conversations professionally and compassionately.

Work Shift: Rotating (United States of America)

Worker Sub Type: Regular

Primary Location Address: 3500 Horizon Drive, King of Prussia, PA