Pharmacy Technician – Prescription Routing, Claims Support

This is a fully remote position, open to applicants in Arizona, +25 more states.

📋 Description

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

• Assessing and updating patient insurance through payer portals and telephone resources.

• Identifying situations that require prior authorization (PAs) using payer-specific tools; managing denials and escalations.

• Implementing reroute best practices for orders that deviate from the standard workflow, 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, including non-contracted pharmacies, state shipping modifications, PP send-backs, and transfers not received, among others.

• Diligently documenting process notes with precise routing information, claim updates, and actions taken.

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

• Collaborating with At-Risk, Partner Management, and PPM teams to escalate or flag orders based on system outages, stock challenges, or policy denials.

• Maintaining productivity in 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 consistent 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, ideally in a Specialty, Mail Order, PBM (with Manufacturer and Insurance troubleshooting experience), or Retail environment.

• Proficient knowledge of:

• - 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 nuances.

• - Medicaid/Medicare experience.

• - Routing tools and reroute resolution logic.

• - Ability to work efficiently and with meticulous attention to detail, particularly when dealing with complex reroutes.

• - Strong skills in written documentation and case management.

🏝️ Benefits

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

• 401(k) plan.

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

• A collaborative, mission-driven team culture that emphasizes innovation and patient care.