Specialty Pharmacy Rep- KOP

Primary Responsibilities

• Drives refill queues and assists patients, physicians, and pharmacists in completing tasks such as claim adjudication/review, benefit investigations, financial assistance applications, refill/adherence activities, and other programs.
• Enters patient information into therapy-specific patient assessment software, including name, date of birth, insurance information, allergies, and medication history.
• Schedules delivery of high-dollar/specialty medications and other maintenance medications to ensure patient adherence and compliance.
• Assesses patient needs for clinical intervention and identifies barriers to care, non-compliance, and changes in therapy/dosing.
• Escalates identified issues to the clinical support team when necessary.
• Reviews patient charts to ensure all information is accurate and up-to-date.
• Explains insurance coverage to patients regarding their copay responsibility and available financial resources.
• Screening patients for financial assistance and applying on their behalf when appropriate.
• Prints paperwork and fills prescriptions under the supervision of a clinical pharmacist.
• Tracks and monitors deliveries to ensure medications arrive undamaged and intervenes if necessary to reship deliveries.
• Contributes to departmental Quality Assurance/Quality Improvement activities.

Essential Functions

• Adjudicates and reviews claims responses for reimbursement and profitability.
• Analyzes claims messages to determine next steps for order escalation, such as Prior Authorization, Benefits Investigation, Step Therapy, Non-Formulary, Financial Assistance, etc.

Other Functions And Competencies

• Liaison between patients and insurance companies, foundations, and manufacturers.
• Knowledge of commercial, Medicaid, and Medicare billing and understanding of program requirements for all types of coverage.
• Demonstrated ability to listen skillfully, collect relevant information, and build relationships and trust with patients and providers.
• Responds to customers in a compassionate manner, multi-tasks between several issues at once, and problem-solves 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 documents and recognizes cause and effect trends.
• Knowledge and understanding of medical terminology, the Health Insurance Portability and Accountability Act, and 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 and ability to utilize practices, tools, and techniques for communicating with a customer.

Education/Training Requirements

• A high school diploma or GED equivalent preferred.
• An 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.