Specialty Pharmacy Tech - Patient Care & Claims Expert

Thomas Jefferson University Hospitals, Inc.; Pennsylvania; On-site; USD 25,000 - 39,000; Full time

Job summary

Thomas Jefferson University Hospitals, Inc. seeks a Specialty Pharmacy Representative I to drive refill queues, assist patients and providers, and support pharmacist-led operations in a King of Prussia pharmacy setting.

Responsibilities include adjudicating claims, coordinating benefits and financial assistance, scheduling deliveries, and ensuring accurate charting and insurance explanations. Strong communication and basic clinical software skills are essential.

Qualifications

• High School Diploma or GED equivalent preferred
• AS/BS degree preferred; Certified Pharmacy Technician (CPhT) preferred

Responsibilities

• Adjudicate and review claims responses for reimbursement and profitability
• Analyze claims messages to determine next steps for order escalation as needed
• Schedule delivery of high dollar/specialty medications and other maintenance meds to maintain patient adherence
• Assess patient need for clinical intervention based on refill responses and information provided
• Identify barriers to care and elevate to the clinical support team as appropriate
• Review patient chart to ensure information is accurate and up to date
• Explain insurance coverage to patients regarding 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 medication arrives undamaged
• Contribute to QA/QI activities and participate at least 2% of time
• Interact professionally with coworkers, patients, physicians, payors and staff

Skills

Customer service

Specialty pharmacy experience

Pharmacy software familiarity

Communication skills

Education

AS/BS degree

CPhT preferred

Job description

Thomas Jefferson University Hospitals, Inc. seeks a Specialty Pharmacy Representative I to drive refill queues, assist patients and providers, and support pharmacist-led operations in a King of Prussia pharmacy setting.

Responsibilities include adjudicating claims, coordinating benefits and financial assistance, scheduling deliveries, and ensuring accurate charting and insurance explanations. Strong communication and basic clinical software skills are essential.