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.
EDUCATION & EXPERIENCE:
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.
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. 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.
Henry Ford Hospital