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Pharmacy Technician Specialist
2 months ago
About the Role:
SmithRx is seeking a highly skilled Pharmacy Technician to join our team. As a Pharmacy Technician at SmithRx, you will play a critical role in ensuring timely access to clinically appropriate, cost-effective medication therapy for our members. You will work closely with internal teams, providers, pharmacies, and external stakeholders to navigate the complexities of prescription coverage.
Key Responsibilities:
- Verify eligibility and drug coverage under plan benefit design to ensure accurate claims processing.
- Triage clinical review processes for prior authorization requests according to established protocols.
- Review non-specialty drug prior authorizations and similar requests using criteria, claims history, and plan benefit rules.
- Organize and prioritize multiple requests to ensure timely management of prior authorization cases.
- Build and adjust authorizations within the claims adjudication system following protocols.
- Utilize your pharmacy technician experience to navigate drug products, formulations, and perform basic calculations for accurate claims adjudication.
- Critically assess and synthesize multiple workflows to make sound clinical decisions.
- Collaborate with teams to coordinate outreach, address questions/escalations, and guide processes for timely and appropriate medication coverage.
- Evaluate member clinical situations against medication policies to determine approval or escalate to a Pharmacist for denial.
- Identify when medications require internal or external review based on protocol synthesis.
- Communicate with external stakeholders for approval on drugs with dollar limits.
Requirements:
- High School diploma or GED or equivalent work experience.
- Active Pharmacy Technician license required.
- 2+ years of experience as a Pharmacy Technician.
- 1+ years of experience in prior authorization review (specifically working on the approval side at a PBM or health plan) preferred.
- Proficiency in Windows, MS Office, G-Suite required.
- Critical thinking to navigate complex customized benefit plans to make sound clinical decisions.
- Active listening, conversational speaking skills, with a high degree of empathy.
- Self-starter with ability to multitask, prioritize and manage time effectively.
- Ability to communicate clearly, present complex information to members, clients, pharmacies, providers, and other teams internally.
- Ability to work accurately within protocols and follow appropriate escalation pathways for unique situations or where clarification is needed.
What We Offer:
SmithRx offers a seasonal role with a contract length of 6 months; opportunity for conversion to full-time is available based on performance and business need. New hires will receive a laptop for the work assignment and will be eligible for competitive benefits through our staffing vendor.
