Specialty Pharmacy Rep-Fulfillment Technician

Thomas Jefferson University & Jefferson Health; Lansdale, Buffalo (Montgomery County, NY); On-site; USD 40,000 - 60,000; Full time

Job summary

A leading healthcare provider is seeking a Specialty Pharmacy Representative I to manage refill queues and support patients and healthcare providers. The ideal candidate will have experience in customer service and specialty pharmacy, with strong critical thinking and communication skills. This role involves claim adjudication, financial assistance applications, and ensuring patient adherence to medication regimens.

Qualifications

• Minimum 3 years in customer service; 1 year in specialty pharmacy or healthcare.
• Proficient with computers; typing speed of 35 WPM.
• Experience with Medicare billing preferred.

Responsibilities

• Manage refill queues and support patients and healthcare providers.
• Adjudicate claims and analyze reimbursement processes.
• Engage with patients to identify barriers to care.

Skills

Customer Service

Critical Thinking

Problem Solving

Communication

Detail-oriented

Education

High School Diploma or GED

AS/BS degree

Certified Pharmacy Technician (CPhT)

Tools

Microsoft Office

Clinical Software Systems

Job description

Job Details

The Specialty Pharmacy Representative I manages refill queues and supports patients, physicians, and pharmacists by completing tasks such as claim adjudication/review, benefit investigations, financial assistance applications, refill/adherence activities, and other programs that optimize outcomes for Jefferson Specialty Pharmacy patients. Responsibilities include entering patient information—name, date of birth, insurance details, allergies, and medication history—into our therapy-specific patient assessment software. Assists with filling and distributing prescriptions under the supervision of a patient care pharmacist, in compliance with legal requirements.

Job Description

Ideal candidate will have experience with high-volume dispensing, production, and fulfillment.

ESSENTIAL FUNCTIONS:

1. Adjudicate and review claims responses for reimbursement and profitability.
2. Analyze claims messages to determine next steps, such as Prior Authorization, Benefits Investigation, Step Therapy, Non-Formulary, Financial Assistance, etc.
3. Schedule delivery of high-dollar/specialty and maintenance medications to ensure patient adherence and compliance according to departmental policies.
4. Assess patient needs for clinical intervention based on refill responses or other provided information.
5. Identify barriers to care, non-compliance, or therapy changes, and escalate to the clinical support team as appropriate.
6. Review and verify patient chart information for accuracy and currency.
7. Explain insurance coverage and patient copay responsibilities, including financial resources available.
8. Screen patients for financial assistance programs and assist with applications.
9. Print documentation and fill prescriptions under pharmacist supervision.
10. Track deliveries to ensure medication arrives undamaged; reship as necessary.
11. Participate in departmental Quality Assurance/Quality Improvement activities, contributing at least 2% of time, with increased participation as needed.
12. Engage with co-workers, visitors, and staff in alignment with Jefferson's iSCORE values.

OTHER FUNCTIONS AND COMPETENCIES:

• Serve as liaison between patients, insurance companies, foundations, and manufacturers.
• Understand billing processes for commercial, Medicaid, and Medicare coverage.
• Demonstrate active listening, relationship-building, and trust with patients and providers.
• Respond compassionately to customer inquiries.
• Manage multiple issues simultaneously.
• Resolve complex customer conflicts professionally, including issues with damaged products, orders, or balances.
• Document trends and analyze causes and effects.
• Possess knowledge of medical terminology, insurance terminology, HIPAA, and patient rights and responsibilities.
• Utilize software and technology effectively to communicate with customers via phone, web, or electronic means.
• Support customer inquiries efficiently and bring problems to resolution.

EDUCATIONAL/TRAINING REQUIREMENTS:

High School Diploma or GED preferred.

_________________________________________________________________________

CERTIFICATES, LICENSES, AND REGISTRATIONS:

Preferred: AS/BS degree; Certified Pharmacy Technician (CPhT).

_________________________________________________________________________

EXPERIENCE REQUIREMENTS:

Minimum 3 years in a customer service role; at least 1 year in a specialty pharmacy, hospital, health insurance, or related healthcare environment.

_________________________________________________________________________

ADDITIONAL INFORMATION:

• Proficient with computers and Microsoft Office; typing speed of 35 WPM.
• Strong critical thinking and problem-solving skills.
• Experience with clinical software systems, specialty medications, and Medicare billing preferred.
• Effective communication skills, both written and verbal.
• Flexible and adaptable to departmental needs.
• Detail-oriented with excellent organizational skills.
• Ability to handle difficult conversations professionally and empathetically.

Work Shift

Day shift (United States of America).

Worker Sub Type

Regular.

Primary Location Address

3500 Horizon Drive, King of Prussia, PA, USA.