Specialty Pharmacy Refill & Benefits Specialist

Jefferson Health; Texas; On-site; USD 42,000 - 65,000; Full time

Job summary

Jefferson Health's Jefferson Specialty Pharmacy seeks a Specialty Pharmacy Representative I to drive refill queues and assist patients, physicians, and pharmacists. You will enter patient data, help with claim adjudication, benefits investigations, and financial assistance, and schedule deliveries under supervision of a pharmacist.

The role emphasizes accurate data entry, adherence support, and compassionate communication as part of a dedicated team delivering high-quality care across our

Qualifications

• High School Diploma or GED equivalent preferred.
• AS/BS degree preferred; Certified Pharmacy Technician (CPhT) preferred.
• 3+ years experience in customer service; 1+ years experience in a specialty pharmacy, hospital, health insurance company, or related healthcare environment.

Responsibilities

• Adjudicate and review claims responses for reimbursement and profitability.
• Analyze claims messages to determine next steps for order escalation (PA, BI, 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 discussions.
• Identify barriers to care and elevate to clinical support when appropriate.
• Review patient chart to ensure accuracy and currency.
• Explain insurance coverage related to copay and financial resources.
• Screen for financial assistance and apply where applicable.
• Print paperwork and fill prescriptions under supervision of a clinical pharmacist.
• Track and monitor deliveries to ensure arrival in good condition.

Skills

Customer service

Pharmacy knowledge

Claims adjudication

Data entry

Education

High School Diploma

AS/BS degree preferred

Certified Pharmacy Technician (CPhT) preferred

Tools

Therapy‑specific software

Microsoft Office

Job description

Jefferson Health's Jefferson Specialty Pharmacy seeks a Specialty Pharmacy Representative I to drive refill queues and assist patients, physicians, and pharmacists. You will enter patient data, help with claim adjudication, benefits investigations, and financial assistance, and schedule deliveries under supervision of a pharmacist.

The role emphasizes accurate data entry, adherence support, and compassionate communication as part of a dedicated team delivering high-quality care across our