Pharmacy Benefits Specialist - Ambulatory Pharmacy - Full Time

GENERAL SUMMARY :

This Employee will work with both outpatient pharmacy and inpatient

Eligible for Sign-on bonus of 2,

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 :

• This employee will work with both outpatient pharmacy and inpatient.
• Outpatient pharmacy : Verifies patient prescriptions benefits, including medical and pharmacy coverage, to ensure accurate billing and reimbursement.
• Inpatient pharmacy : works in the ER department with inpatient pharmacy to complete medication history for patients admitted to the hospital.
• Performs benefits investigation, prescription prior authorization, and research 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.
• 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. Ensures the process is completed quickly, accurately, and in accordance with patient’s needs 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.
• 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, Therapy, or Dromos PTM) experience is preferred.

Additional Information

Organization : Community Care Services

Department : Ambulatory Pharmacy West Bloom

Shift : Rotating

Union Code : Not Applicable