Number of Positions In Requisition
1


Job Details
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
EDUCATIONAL/TRAINING REQUIREMENTS: High School Diploma or GED equivalent preferred _________________________________________________________________________ CERTIFICATES, LICENSES, AND REGISTRATION: AS/BS degree preferrered; 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 orientated 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 ________________________________________________________________________
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
Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 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 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 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.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.
Benefits
Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.
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