Pharmacy Benefits Specialist (Pharmacy Advantage, Specialty) - Rochester Hills, MI
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.
Equal Employment Opportunity/Affirmative Action Employer