Specialty Pharmacy Representative

Specialty Pharmacy Representative I

The Specialty Pharmacy Representative I drives our refill queues and assists patients, physicians and pharmacists in the completion of: claim adjudication/review, benefit investigations, financial assistance applications, refill/adherence activities, and other programs that drive optimal outcomes for Jefferson Specialty Pharmacy patients. Responsibilities include entering the patient information; name, date of birth, insurance information, allergies and medication history into our therapy-specific patient assessment software. Assist with the filling and distribution of prescriptions, under the direction of a patient care pharmacist, in accordance with the law.

Essential Functions:

• Adjudicate and review claims responses for reimbursement and profitability
• Analyze claims messages to determine next steps for order escalation as needed: Prior Authorization, Benefits Investigation, Step Therapy, Non-Formulary, Financial Assistance, etc
• Schedule delivery of high dollar/specialty medications as well as other maintenance medications to maintain patient adherence and compliance to prescribed therapy according to departmental policy and guidelines
• Assess patient need for clinical intervention based on how they answer the refill questions or any information they may provide unrelated to the refill assessment
• Identify any barriers to care, non-compliance, changes in therapy/dosing and escalate to the clinical support team when appropriate
• Review patient chart to ensure all information is accurate and up to date
• Explain insurance coverage to patients as it relates to their copay responsibility and financial resources available to them
• Screen patients for financial assistance and apply on their behalf where applicable
• Print paperwork and fill prescriptions under the supervision of a clinical pharmacist
• Track and monitor deliveries to ensure medication arrives to patient undamaged; intervene where necessary to reship delivery
• Contributes to departmental Quality Assurance/Quality Improvement activities. Expected participation no less than 2% of time increased participation based on need/project.
• Interacts with co-workers, visitors, and other staff consistent with the iSCORE values of Jefferson

Educational/Training Requirements: High School Diploma or GED equivalent preferred

Certificates, Licenses, and Registration: AS/BS degree preferred; Certified Pharmacy Technician (CPhT) preferred

Experience Requirements: 3+ years experience in customer service role 1+ years experience in a specialty pharmacy, hospital, health insurance company, benefits department or other related healthcare environment.

Work Shift: Workday Day (United States of America)

Worker Sub Type: Regular

Employee Entity: Thomas Jefferson University Hospitals, Inc.

Primary Location Address: 3500 Horizon Drive, King of Prussia, Pennsylvania, United States of America

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.