Specialty Pharmacy Care & Reimbursement Specialist

Thomas Jefferson University Hospitals, Inc.; Raleigh (NC); On-site; USD 42,000 - 62,000; Full time

Job summary

Thomas Jefferson University Hospitals, Inc. is seeking a Specialty Pharmacy Representative I to support refill queues and assist patients, physicians, and pharmacists with adjudication, benefit investigations, and financial assistance programs.

This role ensures accurate patient data entry and helps with dispensing under a pharmacist's direction. The position involves coordinating high-value medication deliveries, addressing insurance copay challenges, and liaising with care teams to optimize

Qualifications

• High School Diploma or GED equivalent preferred.
• AS/BS degree preferred; CPhT certification preferred.

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 adherence.
• Assess patient need for clinical intervention based on refill questions or related information.
• Identify barriers to care and escalate to clinical support when appropriate.
• Review patient chart for accuracy and completeness.
• Explain insurance coverage to patients regarding copays and resources.
• Screen patients for financial assistance and apply when applicable.
• Print paperwork and fill prescriptions under supervision of a clinical pharmacist.

Skills

Claims adjudication

Benefits investigation

Patient communication

Pharmacy terminology

Financial assistance

Delivery coordination

Education

AS/BS degree preferred

Certified Pharmacy Technician (CPhT) preferred

Tools

Patient assessment software

Job description

Thomas Jefferson University Hospitals, Inc. is seeking a Specialty Pharmacy Representative I to support refill queues and assist patients, physicians, and pharmacists with adjudication, benefit investigations, and financial assistance programs.

This role ensures accurate patient data entry and helps with dispensing under a pharmacist's direction. The position involves coordinating high-value medication deliveries, addressing insurance copay challenges, and liaising with care teams to optimize