Specialty Pharmacy Representative

** Job Details
*
* PRIMARY RESPONSIBILITIES:

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.
** Job Description
*
* 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.

OTHER FUNCTIONS AND

COMPETENCIES:

• Act as a liaison between the patient and their insurance company, foundations, and manufacturers  
• Knowledge of commercial, Medicaid, and Medicare billing and understanding program requirements for all types of coverage  
• Demonstrated ability to listen skillfully, collect relevant information, and build relationship and trust with patients and providers  
• Respond to customers in a compassionate manner  
• Multi-task between several issues at one time  
• Problem solve to serve patients and ensure their medications are processed, ordered and delivered in a timely manner.  
• Independently resolves 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 the following: medical terminology and medical terminology used by insurance, the Health Insurance Portability and Accountability Act, and of principles and practices associated with the rights and responsibilities of patients and caregivers.  
• Knowledge of and ability to utilize software, technologies and applications to interact with customers via a telephone, web or other electronic means.  
• Knowledge of the major responsibilities, accountabilities, and overall organization of the customer support function or department, ability to properly support customer inquiries and bring problems to a timely resolution.  
• Knowledge of and ability to utilize practices, tools, and techniques for communicating with a customer
** 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…