Pharmacy Tech- Specialty Pharmacy Rep- King of Prussia

Thomas Jefferson University Hospitals, Inc.; United States; On-site; USD 40,000 - 55,000; Full time

Benefits offered by this job

Medical insurance

Tuition assistance

Retirement plans

Job summary

Jefferson Specialty Pharmacy in King of Prussia, PA seeks a Pharmacy Representative I to manage refill queues, assist patients, physicians, and pharmacists with claim adjudication, benefit investigations, and financial assistance applications. You will enter patient data into our therapy-specific software and help with filling and distributing prescriptions under a patient care pharmacist's supervision.

The role emphasizes accurate chart reviews, insurance explanations, adherence tracking, and

Qualifications

• 3+ years experience in customer service
• 1+ years experience in a specialty pharmacy or healthcare setting

Responsibilities

• Adjudicate and review claims for reimbursement
• Schedule delivery of specialty meds to ensure adherence
• Explain insurance coverage and copay responsibilities
• Screen patients for financial assistance
• Print paperwork and fill prescriptions under supervision

Skills

Customer service

Pharmacy software

Claim adjudication

Insurance benefits

Education

AS/BS degree preferred

CPhT preferred

Tools

Clinical software systems

Microsoft Office

Job description

Location

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

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

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 escalates 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

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

About Jefferson

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 schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

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. For more benefits information, please click here

In keeping with Jefferson's Mission, We Improve Lives, it is our goal to recruit, retain, develop and reward highly-qualified employees. If you are enthusiastic, caring and dedicated to service excellence, we invite you to consider joining Jefferson. Jefferson encourages its employees to expand their knowledge and develop their careers through growth opportunities and continuing education. With a long standing history, Jefferson has been advancing the medical field from the heart of Center City Philadelphia for nearly 200 years. Our Mission, We Improve Lives, expands to every corner of the organization. From our weekly farmer’s market, to our new Jefferson Accelerator Zone for innovation, our employees’ passion for the community is evident by the daily gestures towards our patients, students and each other.