Eligible for a $2,500 Sign on bonus Join Henry Ford Health as a Pharmacy Benefits Specialist and make an exciting impact on patient care. GENERAL SUMMARY:
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 and coordinating prior authorization and exception processes. PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Performs benefits investigation, prescription prior authorization, and researches financial assistance needed to ensure patients have access to medications needed.
- Acts as a central resource to manage and monitor all medication related inquiries from providers/clinics.
- Interprets patient treatment plans and medical notes for purposes of facilitating patient care.
- Communicates in timely manner to patients and providers regarding authorization outcome.
- Evaluates any pharmacy related inquiries (i.e., financial barriers, therapy management related outcomes, non-adherence to therapy) and communicates with nursing, providers, social workers and physician staff any additional requirements or potential barriers to the treatment plan.
- Performs all necessary steps during order entry to ensure order gets to final verification.
- Performs online ordering of prescriptions submitted to pharmacies.
- Communicates directly with enrolled patients to ensure that they are supported throughout their therapy regimen and achieve their intended outcome. This includes:
- Conducts outbound phone calls for patient support, adherence checks, and refill reminders.
- Accepts inbound calls from patients and addressing patient needs.
- Appropriately triages clinical questions to the appropriate clinician (pharmacist, nurse, or provider).
- Obtains and documents medication history in appropriate software systems.
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.
- Knowledge in the specialty disease states (Oncology, Autoimmune Disease, Neurology, Hepatology, other miscellaneous Specialty Diseases) preferred.
- Experience working with multidisciplinary team.
- Knowledge of benefits investigation, prior authorization support, and patient financial assistance work preferred.
- Requires a strong understanding and knowledge of medical/clinical and pharmacy terminology.
- Proficiency in standard workplace software (MS office) required.
- EMR systems (Epic or Cerner), dispensing systems (McKesson Enterprise, QS1, or RX30) and specialty pharmacy patient management programs (Asembia-1, Therigy, or Dromos PTM) experience is preferred.
- Requires organizational and time management skills, as evidenced by the capacity to prioritize multiple tasks and job duties/responsibilities
Additional Information
- Organization: Community Care Services
- Department: Ambulatory Pharmacy West Bloom
- Shift: Rotating
- Union Code: Not Applicable
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Henry Ford Health System
Jan 11, 2025