Specialty Pharmacy Rep- KOP

Location: 3500 Horizon Dr, King of Prussia, PA 19406. Responsibilities Adjudicate and review claim 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 and 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 refill questions or other information. Identify 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, including copay responsibilities and available financial resources. 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 medications arrive to patient undamaged; intervene where necessary to reship delivery. Contribute to departmental Quality Assurance/Quality Improvement activities. Interact with co‑workers, visitors, and other staff consistently with Jefferson’s iSCORE values. Additional Functions and Competencies Act as liaison between patient and insurance company, foundations, and manufacturers. Knowledge of commercial, Medicaid, and Medicare billing and understanding program requirements for all coverage types. Demonstrated ability to listen skillfully, collect relevant information, and build relationships and trust with patients and providers. Respond to customers in a compassionate manner. Multi‑task across several issues concurrently. Problem‑solve to serve patients and ensure medications are processed, ordered and delivered in a timely manner. Resolve complex customer conflicts including but not limited to: damaged/lost products, order placement, and outstanding balances and invoices. Proactively document and recognize cause‑and‑effect trends. Knowledge and understanding of medical terminology, HIPAA, and rights/responsibilities of patients and caregivers. Utilize software, technologies and applications to interact with customers via telephone, web or other electronic means. Support customer inquiries and bring problems to a timely resolution. Communicate with patients, physicians, payors and clinical staff professionally and efficiently in writing and verbally. 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 a customer‑service role. 1+ years experience in a specialty pharmacy, hospital, health‑insurance company, benefits department or other related healthcare environment. Additional Information Proficient in the use of computers and Microsoft applications. Type 35 words per minute. Critical‑thinking skills to solve problems and make informed decisions; ability to learn from previous experiences. Experience with clinical software systems; specialty medications and Medicare billing highly preferred. Ability to communicate professionally and efficiently in both written and verbal format with patients, physicians, payors and clinical staff in‑person and on the phone. Flexibility to adapt to changes in departmental needs, including assisting other team members and adjusting assignments. Detail‑oriented with excellent organization skills, ability to learn quickly. Ability to adapt in a dynamic work environment. Demonstrated ability to handle difficult conversations in a professional and caring manner. EEO Statement 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. #J-18808-Ljbffr Thomas Jefferson University Hospitals, Inc.