Pharmacy Benefits Specialist: Prior Authorization & Claims

Henry Ford Health; Rochester Hills (MI); On-site; USD 60,000 - 85,000; Full time

Job summary

Henry Ford Health in Detroit, MI, seeks a Pharmacy Benefits Specialist - Prescription Intake to adjudicate drug claims, manage prior authorizations, and address benefit inquiries from members, patients, physicians, and pharmacies. The role requires strong pharmacy terminology knowledge and Michigan licensure.

Exposure to EMR and dispensing systems like Epic, Cerner, McKesson Enterprise, QS1, RX30, and specialty programs (Asembia-1, Therigy, Dromos PTM) is preferred to support compliant,

Qualifications

• Requires a high school diploma or GED; associates degree preferred.
• Requires State of Michigan Pharmacy Technician License.
• Minimum of two years of pharmacy technician experience.
• Experience as a specialty pharmacy technician preferred.
• Knowledge of specialty disease states preferred.
• Knowledge of benefits investigation, prior authorization support, and patient financial assistance preferred.
• Strong understanding of medical/clinical and pharmacy terminology.
• EMR/ dispensing software experience preferred (Epic, Cerner, McKesson, QS1, RX30, and specialty programs).

Responsibilities

• Adjudicate complex drug claim issues with precision and clinical accuracy.
• Process and manage prescription prior authorization requests according to protocols.
• Resolve pharmacy benefit coverage inquiries for members, patients, physicians, pharmacies, and stakeholders.
• Coordinate prior authorization and exception processes for timely resolution.
• Serve as subject matter expert in benefit coverage and clinical decision support.
• Maintain knowledge of specialty disease states and related benefit requirements.
• Ensure determinations comply with regulatory requirements and policies.

Skills

Pharmacy terminology

Education

High school diploma or GED

Associates degree preferred

Tools

Epic

Cerner

McKesson Enterprise

QS1

RX30

Asembia-1

Therigy

Dromos PTM

Job description

Henry Ford Health in Detroit, MI, seeks a Pharmacy Benefits Specialist - Prescription Intake to adjudicate drug claims, manage prior authorizations, and address benefit inquiries from members, patients, physicians, and pharmacies. The role requires strong pharmacy terminology knowledge and Michigan licensure.

Exposure to EMR and dispensing systems like Epic, Cerner, McKesson Enterprise, QS1, RX30, and specialty programs (Asembia-1, Therigy, Dromos PTM) is preferred to support compliant,