Pharmacy Tech- Specialty Pharmacy Rep- King of Prussia

Health Partners Plans; Pennsylvania; Presencial; USD 25.000 - 30.000; Jornada completa

Descripción de la vacante

Thomas Jefferson University Hospitals, Inc. in King of Prussia, PA, seeks a Specialty Pharmacy Representative I to drive refill queues and assist patients, physicians, and pharmacists with claim adjudication, benefits investigations, and financial assistance programs under supervision of a patient care pharmacist.

You will enter patient data, coordinate prescription deliveries, explain insurance coverage, screen for financial aid, and support QA activities.

Formación

• 3+ years experience in customer service
• 1+ years experience in a specialty pharmacy, hospital, health insurance company, benefits department or other related healthcare environment
• AS/BS degree preferred; CPhT preferred

Responsabilidades

• Adjudicate and review claims responses for reimbursement and profitability
• Analyze claims messages to determine next steps for order escalation (Prior Authorization, Benefits Investigation, Step Therapy, Non-Formulary, Financial Assistance)
• Schedule delivery of high dollar/specialty medications to maintain patient adherence
• Assess patient need for clinical intervention based on refill responses
• Identify barriers to care and escalate to clinical support as needed
• Review patient chart to ensure information is accurate and up to date
• Explain insurance coverage related to copays and financial resources
• Screen patients for financial assistance and apply on their behalf
• Print paperwork and fill prescriptions under supervision of a clinical pharmacist
• Track and monitor deliveries to ensure medications arrive undamaged

Conocimientos

Customer service

Communication

Critical thinking

Attention to detail

Educación

High School Diploma or GED

AS/BS degree preferred

Certified Pharmacy Technician (CPhT) preferred

Herramientas

Microsoft Office

Clinical software systems

Descripción del empleo

Number of Positions In Requisition

0

Job Details

PRIMARY RESPONSIBILITIES:
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

Job Description

Location: Jefferson Specialty Pharmacy
Address: 3500 Horizon Dr, King of Prussia, PA 19406

ESSENTIAL FUNCTIONS

• 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 escalated 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

EDUCATIONAL/TRAINING REQUIREMENTS

High School Diploma or GED equivalent preferred

CERTIFICATES, LICENSES, AND REGISTRATION

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

EXPERIENCE REQUIREMENTS

• 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.

ADDITIONAL INFORMATION

• 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
• Experience with clinical software systems; Specialty Medications and Medicare billing is highly preferred.
• 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

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Thomas Jefferson University Hospitals, Inc. Primary Location Address 3500 Horizon Drive, King of Prussia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three scho