Pharmacy Benefits Specialist -… at Henry Ford… · Rochester…

Company Description

At Henry Ford Health, we're committed to advancing health and improving lives for the millions of people we serve across Michigan and around the world. As one of the nation's leading academic health systems, we provide a comprehensive continuum of care that includes primary and preventive services, specialty and complex care, virtual care, pharmacy, home health, eye care, health insurance, and more. With 12 hospitals and hundreds of ambulatory care locations, including former Ascension Southeast Michigan and Flint Region facilities, our growing network expands access to exceptional care in the communities we serve.

Headquartered in Detroit, Henry Ford Health is helping shape the future of healthcare through the transformative Future of Health: Detroit initiative, a $3 billion investment that is redefining our academic healthcare campus and advancing innovation, research, education, and community impact.

Our work is grounded in purpose, collaboration, and belonging. We empower team members to grow their careers, contribute innovative ideas, and make a meaningful difference every day. Whether you're caring for patients, supporting operations, conducting research, or driving new solutions, you'll be part of a team united by a shared mission: delivering exceptional care, advancing health outcomes, and building healthier communities for all.

Job Description

The Pharmacy Benefits Specialist - Prescription Intake serves as a critical subject matter expert responsible for the authoritative resolution of pharmacy benefit coverage issues, drug claim adjudication, prescription prior authorization, and comprehensive pharmacy benefit inquiries from members, patients, physicians, pharmacies, and internal and external stakeholders. This position requires demonstrated expertise in coordinating complex prior authorization and exception processes while maintaining strict adherence to regulatory and clinical standards.

• Adjudicate complex drug claim issues with precision and clinical accuracy
• Process and manage prescription prior authorization requests in accordance with established protocols and clinical guidelines
• Resolve pharmacy benefit coverage inquiries from members, patients, physicians, pharmacies, and other stakeholders with authoritative expertise
• Coordinate prior authorization and exception processes to ensure timely and compliant resolution
• Serve as a subject matter expert in pharmacy benefit coverage determination and clinical decision support
• Maintain comprehensive knowledge of specialty disease states and their associated pharmacy benefit requirements
• Ensure all determinations comply with regulatory requirements and organizational policies

Qualifications

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.