Specialty Pharm Rep

Job Details

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.

EDUCATIONAL/TRAINING REQUIREMENTS:

High School Diploma or GED equivalent preferred

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:

* 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

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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.