Specialty Pharmacy Service Representative

A Brief Overview

The Specialty Pharmacy Representative serves as a key point of contact for patients, providing support with prescription management, insurance inquiries, and medication adherence. Working under direct supervision in a fast‑paced environment, this role involves handling high volumes of inbound and outbound communication, coordinating refills and deliveries, verifying benefits, and resolving claim issues. Representatives are also responsible for completing patient registration, maintaining accurate records, documenting interactions, and escalating complex matters to pharmacists or senior staff as needed.

Stanford Health Care

• Answer patient calls:
  Address questions about prescriptions, refills, insurance information, and other related topics.
• Medication Management:
  Ensure patients remain on track with medication regimen—outbound therapy/medication adherence checkups; secure refill prescriptions. Contacts clients to schedule deliveries, confirm address, inform them of any financial responsibility.
• Troubleshooting and resolving issues:
  Assist with claim rejections, verify insurance information, and help with program eligibility.
• Data entry and record‑keeping:
  Update patient information, document calls, and maintain records.
• Escalating complex issues:
  Provide assistance to Pharmacists, both those in the facility and those at other locations. Identify and communicate issues to senior level staff as appropriate.
• Providing customer service:
  Communicate with clients as needed regarding the fulfillment of prescription refills and refer any health‑related concerns to a healthcare professional when required.
• Following company procedures:
  Adhere to established protocols and guidelines for handling calls and resolving issues.
• Maintaining confidentiality:
  Ensure the privacy and security of patient information.
• Perform other duties and responsibilities as assigned.

• High school diploma or general education degree (GED)

• One year minimum call center experience, or other related experience providing customer service to internal and external customers, including meeting quality standards for services and evaluating customer satisfaction.
• Experience in insurance, medical, or pharmacy environments is required.

• Ability to adapt to and deal with change and ambiguity.
• Ability to plan, organize, prioritize, work independently and meet deadlines.
• Ability to solve problems and identify solutions.
• Ability to speak and write effectively at a level appropriate for the job.
• Ability to work effectively with individuals at all levels of the organization.
• Ability to work in a fast‑paced work environment.
• Knowledge of local, state and federal regulatory requirements related to areas of functional responsibility.
• Knowledge of Medical terminology and abbreviations; and disease states.
• Strong interpersonal communication skills.
• Knowledge of computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications.
• Knowledge of Microsoft Outlook and Word.
• Knowledge of inflammatory diseases, infectious disease, and/or oncology.

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C‑I‑CARE standards for all of patients, families and towards each other. C‑I‑CARE is the foundation of Stanford’s patient‑experience and represents a framework for patient‑centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me:
  Anticipate my needs and status to deliver effective care
• Show Me the Way:
  Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me:
  Own the complexity of my care through coordination