Specialty Pharmacy Care Navigator

Jefferson Health; King of Prussia (PA); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Tuition assistance

Prescription coverage

Job summary

Jefferson Specialty Pharmacy in King of Prussia is seeking a Pharmacy Tech- Specialty Pharmacy Rep to drive refill queues and assist patients, physicians and pharmacists with claim adjudication, benefit investigations, and financial assistance applications. You will enter patient data into therapy-specific software and help with filling and distribution under a patient care pharmacist.

Requirements include AS/BS degree or CPhT preferred, and 3+ years in customer service with exposure to

Qualifications

• 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.

Responsibilities

• 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 and maintenance meds to maintain patient adherence.
• Assess patient need for clinical intervention based on refill questions or other information.
• Identify barriers to care and escalate to the clinical support team when appropriate.
• Explain insurance coverage related to copays and financial resources.
• Screen patients for financial assistance and apply on their behalf where applicable.
• Print paperwork and fill prescriptions under supervision of a clinical pharmacist.
• Track and monitor deliveries to ensure proper arrival; intervene if reshipment is needed.
• Participate in quality assurance/improvement activities.

Skills

Customer service

Pharmacy knowledge

Communication skills

Attention to detail

Education

AS/BS degree preferred

Certified Pharmacy Technician (CPhT) preferred

Tools

MS Office

Pharmacy software

Claims management

Job description

Jefferson Specialty Pharmacy in King of Prussia is seeking a Pharmacy Tech- Specialty Pharmacy Rep to drive refill queues and assist patients, physicians and pharmacists with claim adjudication, benefit investigations, and financial assistance applications. You will enter patient data into therapy-specific software and help with filling and distribution under a patient care pharmacist.

Requirements include AS/BS degree or CPhT preferred, and 3+ years in customer service with exposure to