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Pharmacy Technician for Prior Authorization Services

2 months ago

Plano, Texas, United States SmithRx Full time
Job Overview

About Us:

SmithRx is an innovative, rapidly expanding Health-Tech organization focused on transforming the Pharmacy Benefit Management (PBM) industry. Our goal is to create a state-of-the-art drug acquisition platform that leverages advanced technology, effective cost-saving tools, and exceptional customer service. Since our inception in 2016, we have successfully onboarded hundreds of thousands of members, proving that our solutions resonate with clients nationwide.

We take pride in fostering a mission-driven and collaborative work environment that motivates our employees to excel. We believe in the necessity of reforming the U.S. healthcare system and are committed to making this vision a reality. Our core values guide us:

  • Integrity: We operate with honesty and transparency to build trust with our clients.
  • Courage: We embrace the challenge of improving a flawed industry and continuously enhance our offerings to optimize health outcomes.
  • Collaboration: We cultivate an inclusive atmosphere that values teamwork, respect, open communication, and encourages creativity and diverse perspectives.

Position Summary:

As a Pharmacy Technician at SmithRx, you will be instrumental in assisting members, healthcare providers, pharmacies, and internal teams in navigating the complexities of prescription coverage. Your role will ensure timely access to clinically appropriate and cost-effective medication therapy, aligned with plan benefit design and clinical criteria. Key responsibilities include:

  • Coordinating clinical review cases and verifying coverage.
  • Conducting outreach and reviewing prior authorization requests.
  • Resolving escalations and ensuring efficient management of prior authorization cases.

This is a contract position with a duration of six months, with the potential for conversion to full-time based on performance and business needs. New hires will receive a laptop for their assignments and will be eligible for competitive benefits through our staffing vendor.

Key Responsibilities:

  • Verify eligibility and medication coverage under the plan benefit design to facilitate accurate claims processing.
  • Manage clinical review processes for prior authorization requests in accordance with 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 established protocols.
  • Utilize your pharmacy technician expertise to navigate drug products and perform basic calculations for accurate claims adjudication.
  • Critically assess and synthesize multiple workflows to make informed clinical decisions.
  • Collaborate with teams to coordinate outreach, address inquiries, 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.

Qualifications:

  • High School diploma or GED or equivalent work experience.
  • Active Pharmacy Technician license required.
  • Minimum of 2 years of experience as a Pharmacy Technician.
  • Preferred: 1+ years of experience in prior authorization review, specifically on the approval side at a PBM or health plan.
  • Proficiency in Windows, MS Office, and G-Suite.
  • Strong critical thinking skills to navigate complex customized benefit plans and make informed clinical decisions.
  • Excellent active listening and conversational speaking skills, with a high degree of empathy.
  • Self-starter with the ability to multitask, prioritize, and manage time effectively.
  • Ability to communicate clearly and present complex information to members, clients, pharmacies, providers, and internal teams.
  • Ability to work accurately within protocols and follow appropriate escalation pathways for unique situations or where clarification is needed.