Specialty Pharm Team Lead- KOP

Today, Jefferson Health and its network of hospitals and physician practices serve patients throughout the Delaware Valley. We have a robust network of 18 hospitals, 3500 physicians, 9600 nurses, 3,876 licensed beds, and physician practices throughout the counties of: Bucks Camden Gloucester Montgomery Philadelphia We are Philadelphia#39;s second largest employer, and nationally ranked by US News World Report in seven specialties including #2 Ophthalmology (Wills Eye), #9 Rehabilitation (MossRehab), #10 in Orthopedics (Rothman Orthopaedics at Jefferson Health, Philadelphia Hand to Shoulder Center, 3B Orthopedics, the Abington Orthopedic Spine). Whether yoursquo;re in the city or the suburbs, Jefferson Health provides the exceptional care you expect ndash; close to home or work ndash; through our broad family of primary care physicians and specialists. Jefferson Health is home to nationally ranked experts who provide a personalized care plan for you. Sidney Kimmel Cancer Center ndash; Jefferson Health is one of only 70 NCI-designated cancer centers in the country. With more than 30,000 employees, we are the largest health system in the Philadelphia region by total licensed beds. And our work to improve lives is never done. In keeping with Jefferson#39;s Mission, We Improve Lives, it is our goal to recruit, retain, develop and reward highly-qualified employees. If you are enthusiastic, caring and dedicated to service excellence, we invite you to consider joining Jefferson. Jefferson encourages its employees to expand their knowledge and develop their careers through growth opportunities and continuing education. Culture We are a creative and collaborative team dedicated to outstanding professional work on behalf of our patients. Our goal is to meet our patients#39; needs and help them advocate for themselves and their family members. We believe our place in the community is as a healer, an activist, and a trusted friend. We perform our duties with empathy and compassion as we serve the needs of the underserved population of North Philadelphia. While we do have an academic component to our work, we strive to be community doctors who take pride in serving others. Join us...make a difference. Job Summary The Specialty Pharmacy Representative Team Lead is the subject matter expert for their assigned specialty area and oversees all work queues related to: claim adjudication/review, benefit investigations, financial assistance applications, refill/adherence activities, prior authorizations, payer appeals, fulfillment, and other programs that drive optimal outcomes for Jefferson Specialty Pharmacy patients and provider experiences. Serves as the first point of contact for escalations from the patient care team. Demonstrates the ability to competently work in general and specialty areas of pharmacy practice with limited supervision. Works with specialty pharmacy leadership to develop competencies and standard work flows within the designated area of expertise to optimize performance. Essential Functions Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. Monitor multiple daily work flow queues to ensure appropriate coverage in order to meet established metrics and performance Serve as the first point person for escalated issues from pharmacy care team staff Collaborate with specialty pharmacy leadership, peers, nurses, providers and allied health professionals to improve patient outcomes, quality accreditation metrics in specialized areas of pharmacy practice Conduct complex payer and other funding trouble shooting Participates in the training, competency development, and continuous proficiency of employees in specialized areas of pharmacy practice Complies with established enterprise and departmental policies and procedures, code of conduct, quality improvement, infection control, and safety initiatives Triages and escalates any questions or issues outside the scope of practice of the Specialty pharmacy care staff to the clinical pharmacist or manager as needed Perform Specialty Pharmacy Representative I and II functions Description Ability to 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 Knowledge of and ability to utilize practices, tools, and techniques for communicating with a customer Knowledge of the major responsibilities, accountabilities, and overall organization of the customer support function of the department, ability to properly support customer inquiries and bring problems to a timely resolution Independently resolves complex customer conflicts including but not limited to: damaged/lost products, order placement, and outstanding balances and invoices Problem solve to serve patients and ensure their medications are processed, ordered and delivered in a timely manner. Demonstrated ability to listen skillfully, collect relevant information, and build relationship and trust with patients and providers Ability to respond to customers in a compassionate manner Ability to multi-task between several issues at one time Proactively document and recognize cause and effect trends and assist with implementation of Quality Improvement Plans for process changes Knowledge and understanding of the following: medical terminology and medical terminology used by payers, the Health Insurance Portability and Accountability Act, and of principles and practices associated with the rights and responsibilities of patients and caregivers. Minimum Education and Experience Requirements: Education: High School Diploma or GED equivalent preferred AND Experience: 5+ years experience in customer service role 3+ years experience in a specialty pharmacy, hospital, health insurance company, benefits department or other related healthcare environment. Demonstrated experience to undertake a lead role Minimum Certifications, Registration or License Requirements: AS/BS degree preferred; Certified Pharmacy Technician (CPhT) preferred Additional Information bull; Proficient in the use of computers and Microsoft applications. Type 35 wpm. bull; Critical Thinking skills to solve problems and make informed thought out decisions; ability to learn from and lean on past experiences bull; Experience with clinical software systems; Specialty Medications and Medicare. Medicaid and Commercial billing is highly preferred. bull; 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. bull; Flexibility to adapt to changes in the departmental needs including but not limited to: offering assistance to other team members, adjusting assignments, etc. bull; Detailed orientated with excellent organization skills, ability to learn quickly bull;Ability to adapt in a dynamic work environment bull;Demonstrated ability to handle difficult conversations in a professional and caring manner About Jefferson 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#39;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 educashy;tional 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.

Created: 2024-11-03