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GENERAL SUMMARY:Under the direction of the Department Director or Manager, coordinates and facilitates operations in key department areas such as automation and information services, pharmaceutical waste management, regulatory readiness, purchasing and inventory control, controlled substances diversion monitoring, and other duties and responsibilities as assigned. Approximately 65% of responsibilities are related to automation and associated activities. Works closely with pharmacy, nursing, and other multidisciplinary teams within each business unit.

• This role supports patients’ medication access by managing infusion and injection benefit claims, ensuring financial viability, and addressing affordability concerns throughout the care journey.

• Claims Authorization Support: Efficiently validate insurance coverage and determine when medication prior authorization is required, ensuring accuracy and compliance with insurance guidelines to support timely and appropriate reimbursement.

• Product Selection and Payer Formulary Review: Identify appropriate formulary medications, NDCs, and corresponding HCPCS codes to ensure accurate prior authorization, billing, and reimbursement. Collaborate with pharmacists, healthcare providers, insurance companies, and third parties to resolve payer issues, minimize claim denials, and optimize service delivery for improved patient outcomes.

• Documentation and Compliance: Review electronic medical records to collect pertinent information needed for submitting, appealing, and resolving prior authorizations. Document all activities in compliance with institutional policies, payer requirements, and regulatory standards. Stay informed of changes in insurance policies, payer requirements, and regulatory standards related to medication benefits to ensure compliance and provide accurate information to patients and stakeholders.

• Stakeholder Communication and Engagement: Foster effective communication between care teams, providers, infusion patient access hub and central authorization teams, and external stakeholders to promote collaboration, optimize service delivery, and ensure seamless patient experience.

• Support for Infusion Patient Access Hub Pharmacist and Pharmacy Revenue Cycle team: Collaborate with pharmacy Hub Team and Revenue cycle team to select appropriate formulary medications and optimize pharmacy initiatives.

• Follow-Up and Problem Solving: Conduct proactive follow-ups on prior authorizations and claims status. Identify and address root causes of medication access barriers and provide effective solutions to resolve any issues.

• Claims Management and Appeals: Support audits by reviewing billing and reimbursement activities, monitor appeals and denied claims and support Hub pharmacist as needed with appeals process and address discrepancies to maximize reimbursement and financial accuracy.

• Process Optimization: Identify opportunities for improving infusion patient access hub workflows related to medication access, prior authorizations, and claims resolution. Collaborate with pharmacists and care teams to implement process enhancements that streamline operations and improve service delivery.

• Regulatory Knowledge: Stay informed about changes in medication benefits, insurance policies, and regulations to ensure compliance and provide up-to-date information.

EDUCATION/EXPERIENCE REQUIRED:Requires high school diploma or G.E.D. equivalent. Requires at least two (2) years of experience as an inpatient pharmacy technician (for inpatient setting) OR two (2) years of experience as a pharmacy technician for all others. Two (2) years of experience with automated pharmacy dispensing systems preferred. PC skills as needed to perform job functions as assigned. Strong verbal/written skills; availability for on-call system support; highly analytical ability to solve complex technical problems. Ability to work designated shifts, including weekends and holidays. Ability to function in a fast-paced environment with established time constraints. Flexibility to deal with ever-changing health care environment. Ability to effectively manage multiple projects.

Additional qualifications:

• Minimum of 2 years’ experience in a pharmacy setting, with experience in medication benefits management, specialty pharmacy, or a related field preferred

• Strong working knowledge of insurance benefit structures, payer policies, and access tools (preferred).

• Previous experience in an infusion center or home infusion pharmacy and/or processing prior authorizations is highly desirable

• Certification in pharmacy revenue cycle management by American Society of Health-System Pharmacists (ASHP) required within 6 months of hire

Skills:

o Strong communication and interpersonal skills

o Ability to multitask and handle high-stress situations

CERTIFICATIONS/LICENSURES REQUIRED:Valid State of MI pharmacy technician licensure required.

Additional Information

+ Organization: Corporate Services

+ Department: Pharmacy Admin - Product Line

+ Shift: Day Job

+ Union Code: Not Applicable

Additional Details

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 functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers .

Benefits

The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is

committed to the hiring, advancement and fair treatment of all individuals without regard to

race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

weight, marital status, family status, gender identity, sexual orientation, and genetic information,

or any other protected status in accordance with applicable federal and state laws.