Specialty Pharmacy Representative
4 days ago
We are seeking a highly skilled and detail-oriented Specialty Pharmacy Representative to join our team at Jefferson Health. As a Specialty Pharmacy Representative, you will play a critical role in ensuring the smooth operation of our specialty pharmacy services, providing exceptional customer service, and supporting our patients and healthcare providers.
Key Responsibilities- Assist 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.
- Enter patient information, including 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.
- 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 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.
- Contribute to departmental Quality Assurance/Quality Improvement activities.
- High School Diploma or GED equivalent preferred.
- AS/BS degree preferred; Certified Pharmacy Technician (CPhT) preferred.
- 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.
- Proficient in the use of computers and Microsoft applications.
- Critical Thinking skills to solve problems and make informed thought-out decisions.
- Ability to learn from and lean on past experiences.
- Experience with clinical software systems; Specialty Medications and Medicare billing is 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 the departmental needs.
- Detailed-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.
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