Specialty Pharmacy Claims & Reimbursement Specialist

Health Partners Plans; Pennsylvania; On-site; USD 25,000 - 30,000; Full time

Job summary

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.

Qualifications

• 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

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 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

Skills

Customer service

Communication

Critical thinking

Attention to detail

Education

High School Diploma or GED

AS/BS degree preferred

Certified Pharmacy Technician (CPhT) preferred

Tools

Microsoft Office

Clinical software systems

Job description

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.