Pharmacy Technician – Prescription Routing, Claims Support

📋 Description

• Troubleshooting electronic, faxed, and verbal prescriptions by directing them to the appropriate channels within pharmacy systems.

• Reviewing and updating patient insurance information utilizing payer portals and telephone resources.

• Identifying situations that require prior authorizations (PAs) using payer-specific tools; resolving denials and escalating issues as needed.

• Implementing best practices for rerouting orders that deviate from standard workflows, including those with state changes, insurance exceptions, pharmacy rejections, or failed transfers.

• Effectively navigating operational platforms (e.g., BestRx, Ops Dash, Partner Dash, RelayHealth, etc.) and vendor systems.

• Adhering to reroute protocols for specific tags such as non-contracted pharmacies, state shipping alterations, PP send-backs, transfer non-receipts, and more.

• Proactively documenting process notes with detailed routing information, claim updates, and actions undertaken.

• Engaging with partner pharmacies, provider offices, and insurance carriers to resolve issues or provide clarification on documentation.

• Collaborating with At-Risk, Partner Management, and PPM teams to escalate or flag orders affected by system outages, stock shortages, or policy denials.

• Maintaining productivity within the Reroute queue, even during prolonged call hold times (e.g., multitasking during insurance calls).

• Ensuring that all communications with patients, prescribers, and partners are clear, professional, and in line with Phil’s standards of care.

⛳️ Requirements

• Pharmacy Technician License in the state of residence (mandatory).

• PTCB certification (preferred).

• At least 1 year of experience as a pharmacy technician, preferably in a Specialty, Mail Order, PBM (with Manufacturer and Insurance troubleshooting experience), or Retail environment.

• Proficient knowledge in:

• - Insurance claim rejections (e.g., Reject 50/40, DUR codes, etc.).

• - Prior authorizations, override codes, and split billing scenarios.

• - ICD-10 codes and drug classifications.

• - FSA/HSA card restrictions and processing intricacies.

• - Medicaid/Medicare experience.

• - Routing tools and reroute resolution strategies.

• - Ability to work efficiently and pay attention to detail, especially when managing complex reroutes.

• - Strong written documentation and case management capabilities.

🏝️ Benefits

• Competitive salary and comprehensive benefits package (medical, dental, vision, etc.).

• 401(k) plan.

• Hybrid work model after 90 days (in-office collaboration & remote flexibility).

• A collaborative, mission-driven team culture centered on innovation and patient care.