Specialty Pharmacy Representative

Thomas Jefferson University & Jefferson Health; Lansdale, Buffalo (Montgomery County, NY); On-site; USD 40,000 - 80,000; Full time

Job summary

An established industry player in healthcare is seeking a Specialty Pharmacy Representative I to enhance patient care and ensure optimal outcomes. This role involves managing refill queues, assisting patients with insurance claims, and ensuring adherence to medication schedules. You'll work closely with pharmacists and patients, providing essential support and guidance throughout the medication process. The ideal candidate will have strong communication skills, a background in pharmacy operations, and a passion for helping others. Join a dedicated team committed to making a difference in patient lives while enjoying a supportive work environment.

Qualifications

• Experience in pharmacy operations and patient care.
• Knowledge of insurance processes and billing procedures.

Responsibilities

• Manage refill queues and assist patients with claims and benefits.
• Schedule medication deliveries and monitor patient adherence.
• Serve as a liaison between patients and insurance companies.

Skills

Patient Care

Claims Adjudication

Financial Assistance

Medical Terminology

Customer Service

Education

High School Diploma

Pharmacy Technician Certification

Tools

Therapy-Specific Assessment Software

Insurance Billing Software

Job description

Job Details

PRIMARY RESPONSIBILITIES:

The Specialty Pharmacy Representative I manages refill queues and assists patients, physicians, and pharmacists with claim adjudication, benefit investigations, financial assistance applications, refill/adherence activities, and other programs to ensure optimal outcomes for Jefferson Specialty Pharmacy patients. Responsibilities include entering patient information such as name, date of birth, insurance details, allergies, and medication history into therapy-specific assessment software. Additionally, they assist with filling and distributing prescriptions under the supervision of a patient care pharmacist, in accordance with legal requirements.

Job Description

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 when appropriate.
6. Review and verify accuracy of patient charts.
7. Explain insurance coverage, copay responsibilities, and financial resources to patients.
8. Screen for financial assistance and apply on behalf of patients when applicable.
9. Print paperwork and fill prescriptions under pharmacist supervision.
10. Monitor deliveries to ensure medications arrive undamaged; intervene as necessary to reship.
11. Participate in departmental Quality Assurance/Quality Improvement activities, with a minimum of 2% of time allocated.
12. Interact with co-workers, visitors, and staff in line with Jefferson's iSCORE values.

OTHER FUNCTIONS AND COMPETENCIES:

1. Serve as a liaison between patients, insurance companies, foundations, and manufacturers.
2. Understand billing procedures for commercial, Medicaid, and Medicare coverage.
3. Demonstrate active listening, relationship-building, and trust with patients and providers.
4. Respond compassionately to customer inquiries.
5. Multi-task effectively across multiple issues.
6. Resolve complex customer conflicts independently, including issues related to damaged/lost products, orders, and balances.
7. Document issues and recognize trends for root causes.
8. Possess knowledge of medical terminology, insurance processes, HIPAA, and patient rights.
9. Utilize software and technology effectively for customer interactions.
10. Support customer inquiries efficiently, ensuring timely resolution.

Work Shift

Day shift (United States of America)

Worker Sub Type

Regular

Primary Location Address

3500 Horizon Drive, King of Prussia, Pennsylvania, United States of America

Jefferson is committed to providing equal educational and employment opportunities regardless of age, race, color, religion, creed, sexual orientation, gender identity, marital status, pregnancy, national origin, military status, veteran status, disability, or other protected status.