Pharmacy Benefits Advocate for Prior Authorization & Access

Henry Ford Health; West Bloomfield Charter Township (MI); On-site; USD 52,000 - 76,000; Full time

Job summary

Henry Ford Health is seeking a Pharmacy Benefits Specialist to manage drug claim adjudication issues, prescription prior authorizations, and pharmacy benefit inquiries from members, patients, physicians, and pharmacies. This role acts as a subject matter expert in resolving coverage issues and coordinating authorization processes.

The specialist collaborates with nursing, physicians, payors, and staff to resolve barriers to treatment, ensures timely communication of outcomes, and may perform

Qualifications

• High school diploma or GED; Michigan Pharmacy Tech license.
• Minimum two years pharmacy technician experience.
• Experience with benefits investigation and prior authorization.
• Knowledge of medical/clinical terminology and pharmacy terminology.
• Proficiency with MS Office; EMR experience preferred.

Responsibilities

• Performs benefits investigation and prior authorization; researches financial assistance to ensure patient access.
• Acts as central resource for medication inquiries from providers and clinics.
• Interprets patient treatment plans and medical notes to facilitate patient care.
• Communicates authorization outcomes promptly to patients and providers.
• Evaluates inquiries and communicates barriers to treatment plans; coordinates with care teams.
• Performs order entry to ensure fast, accurate processing and final verification.
• May perform pharmacy technician duties (data entry, dispensing, POS) and prescription delivery.
• Supports patient adherence and therapy monitoring through outbound/inbound calls.

Skills

Benefits investigation

Prior authorization

Patient financial assistance

Communication with patients/providers

MS Office proficiency

Pharmacy terminology

Education

High school diploma or GED

Michigan Pharmacy Technician License

Associates degree preferred

Tools

Epic EMR

Cerner EMR

McKesson QS1

RX30

Job description

Henry Ford Health is seeking a Pharmacy Benefits Specialist to manage drug claim adjudication issues, prescription prior authorizations, and pharmacy benefit inquiries from members, patients, physicians, and pharmacies. This role acts as a subject matter expert in resolving coverage issues and coordinating authorization processes.

The specialist collaborates with nursing, physicians, payors, and staff to resolve barriers to treatment, ensures timely communication of outcomes, and may perform