Specialty Pharmacy Care Coordinator

Jefferson Health Plans; Park (KS); On-site; USD 52,000 - 68,000; Full time

Benefits offered by this job

Medical insurance

Prescription coverage

Retirement plans

Tuition assistance

Job summary

Thomas Jefferson University Hospitals, Inc. is seeking a Specialty Pharmacy Representative I to drive refill queues and assist patients, physicians and pharmacists with claim adjudication, benefits investigations, and financial assistance applications.

The role involves data entry into therapy-specific software, coordinating prescription filling under supervision, and ensuring timely delivery and patient adherence.

Qualifications

• 3+ years experience in customer service
• 1+ years experience in a specialty pharmacy, hospital, health insurance company or related healthcare environment
• Proficient with computers and Microsoft applications; Type 35 wpm

Responsibilities

• Adjudicate and review claims for reimbursement and profitability
• Analyze claims messages to determine next steps (Prior Authorization, Benefits Investigation, etc.)
• Schedule delivery of high dollar/specialty meds to maintain adherence
• Assess patient need for clinical intervention based on refill information
• Identify barriers to care and escalate to clinical support when appropriate

Skills

Customer service

Pharmacy experience

Claims adjudication

Insurance billing

Communication

Education

AS/BS degree preferred

CPhT preferred

Tools

Pharmacy software

Clinical software systems

Job description

Thomas Jefferson University Hospitals, Inc. is seeking a Specialty Pharmacy Representative I to drive refill queues and assist patients, physicians and pharmacists with claim adjudication, benefits investigations, and financial assistance applications.

The role involves data entry into therapy-specific software, coordinating prescription filling under supervision, and ensuring timely delivery and patient adherence.