Pharmacy Benefits Specialist - Contingent - Pharmacy Advantage

Henry Ford Health System; Rochester Hills (MI); On-site; USD 40,000 - 60,000; Full time

Job summary

Join Henry Ford Health as a Pharmacy Benefits Specialist and contribute to the Pharmacy Advantage success. This contingent role involves drug claim adjudication, prior authorization processing, and addressing pharmacy benefit inquiries to ensure patients receive necessary medications efficiently.

Qualifications

• Minimum two years of pharmacy technician experience required.
• State of Michigan Pharmacy Technician License mandatory.
• Experience as a specialty pharmacy technician preferred.

Responsibilities

• Handles drug claim adjudication issues and prior authorizations.
• Performs benefits investigation and prescription prior authorization.
• Communicates with healthcare providers about treatment barriers.

Skills

Customer Service

Pharmacy Benefit Inquiries

Drug Claim Adjudication

Financial Assistance Research

Education

High school diploma or G.E.D.

Associates degree preferred

Job description

Exciting opportunity to join Henry Ford Health as a Pharmacy Benefits Specialist. Make an impact on patient care and contribute to Pharmacy Advantage success.

GENERAL SUMMARY:

Schedule: Contingent, candidate must have a flexible availability, available tentatively 2-3 times a week.

The Pharmacy Benefits Specialist is responsible for handling drug claim adjudication issues, prescription prior authorization, and pharmacy benefit inquiries from members/patients, physicians, pharmacies, and other internal and external individuals.
Is a subject matter expert in the resolution of pharmacy benefit coverage issues andcoordinating prior authorization and exception processes.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Performs benefits investigation, prescription prior authorization, and researchesfinancial assistance needed to ensure patients have access to medications needed.
• Interprets patient treatment plans and medical notes for purposes of facilitating patientcare.
• Evaluates any pharmacy related inquiries (i.e., financial barriers, therapy managementrelated outcomes, non-adherence to therapy) and communicates with nursing,providers, social workers and physician staff any additional requirements or potentialbarriers to the treatment plan.
• Performs all necessary steps during order entry to ensure order gets to final verification.Ensures the process is completed quickly, accurately, and in accordance with patient’sneeds while maintaining the highest customer service/quality of care.
• Performs online ordering of prescriptions submitted to pharmacies.

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and duties. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described above.

EDUCATION/EXPERIENCE REQUIRED:

• Requires a High school diploma or G.E.D. Associates degree preferred
• Requires State of Michigan Pharmacy Technician License.
• Requires a minimum of two years of previous pharmacy technician experience.
• Previous experience as a specialty pharmacy technician preferred.

Additional Information

• Organization: Community Care Services
• Department: Pharmacy Advantage Rochester H
• Shift: Day Job
• Union Code: Not Applicable