Specialty Pharm Team Lead- KOP

Job Details

Job Description

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

Competencies (Knowledge, Skills, and Abilities Required):
Competency

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
* 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. Medicaid and Commercial 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

Worker Sub Type

Primary Location Address

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.