Jefferson
Specialty Pharmacy Representative I
Jefferson, King Of Prussia, Pennsylvania, United States, 19406
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 include adjudicating and reviewing claims responses for reimbursement and profitability, analyzing 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 include acting 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. Educational/training requirements: High School Diploma or GED equivalent preferred. 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. Additional information: Proficient in the use of computers and Microsoft applications. Type 35 wpm. 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 including but not limited to: offering assistance to other team members, adjusting assignments, etc. 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. 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.
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 include adjudicating and reviewing claims responses for reimbursement and profitability, analyzing 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 include acting 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. Educational/training requirements: High School Diploma or GED equivalent preferred. 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. Additional information: Proficient in the use of computers and Microsoft applications. Type 35 wpm. 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 including but not limited to: offering assistance to other team members, adjusting assignments, etc. 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. 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.