Specialty Pharm Rep - King Of Prussia

This position is located at our King of Prussia office: 3500 Horizon Drive King of Prussia, PA

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.

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.

Qualifications

EDUCATIONAL/TRAINING REQUIREMENTS: High School Diploma or GED equivalent

CERTIFICATES, LICENSES, AND REGISTRATION: 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: Knowledge of clinical software systems, Specialty Medications and Medicare billing is highly preferred. Ability to communicate professionally and effectively 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, solve problems and make informed educated decisions.

Conditions of Employment

Covid Vaccination is a requirement for employment at Jefferson for employees working at Jefferson's clinical entities or at the University. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date if you are offered employment, unless you request and receive an approved medical or religious exemption from Jefferson.

Closing Statement

About Jefferson

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 42,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health , nationally ranked as one of the top healthcare systems in the country and the largest provider in the Philadelphia area, serves patients through millions of encounters each year at 17 hospitals and more than 160 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.