Ambulatory Pharmacy Benefits Specialist

Henry Ford Health; Troy (MI); On-site; USD 55,000 - 75,000; Full time

Job summary

Henry Ford Health in Detroit is seeking a Pharmacy Benefits Specialist for ambulatory care to manage drug claim adjudication, prior authorizations, and inquiries from members, physicians, and pharmacies. You will be a subject matter expert in resolving benefit coverage issues and coordinating authorization and exception processes.

The role involves benefits investigation, patient financial assistance, and effective communication of authorization outcomes to patients and providers, ensuring

Qualifications

• Requires a High school diploma or GED; associates degree preferred.
• Michigan Pharmacy Technician license is required.
• Minimum two years of pharmacy technician experience; specialty pharmacy preferred.

Responsibilities

• Handle benefits investigation and prior authorization for patients.
• Research financial assistance to ensure medication access.
• Manage inquiries from providers, clinics, and patients.
• Interpret treatment plans and medical notes for care facilitation.
• Communicate authorization outcomes to patients and providers.
• Order entry steps to ensure timely dispensing and verification.
• Coordinate with nursing, social workers and physician staff on barriers.
• Perform pharmacy technician duties including data entry and dispensing when needed.
• Triaging clinical questions to pharmacists, nurses or providers.
• Document medication history in applicable systems.
• Assist with orientation and training of new hires.

Skills

Benefits investigation

Prior authorization

Multidisciplinary collaboration

Time management

Customer service

Medical terminology

Education

High school diploma or GED

State of Michigan Pharmacy Technician License

Associates degree preferred

Tools

Epic

Cerner

McKesson Enterprise

QS1

RX30

Asembia

Therigy

Dromos PTM

Job description

Henry Ford Health in Detroit is seeking a Pharmacy Benefits Specialist for ambulatory care to manage drug claim adjudication, prior authorizations, and inquiries from members, physicians, and pharmacies. You will be a subject matter expert in resolving benefit coverage issues and coordinating authorization and exception processes.

The role involves benefits investigation, patient financial assistance, and effective communication of authorization outcomes to patients and providers, ensuring