Prior Authorization Pharmacy Technician – Seasonal

This is a fully remote position, open to applicants in Alabama, +46 more states.

📋 Description

• Support members, providers, pharmacies, and internal SmithRx teams in managing the complexities of prescriptions and ensuring timely medication coverage.

• Confirm eligibility and drug coverage based on plan benefit designs for proper claims processing.

• Manage clinical review processes for prior authorization requests in accordance with established guidelines.

• Analyze prior authorization requests utilizing criteria, claims history, and plan benefit regulations.

• Reach out to prescribers and pharmacies to verify and collect necessary information.

• Organize and prioritize requests to ensure effective management of prior authorization cases.

• Create and modify authorizations within the claims adjudication system.

• Navigate through drug products and formulations, performing basic calculations to ensure accurate claims adjudication.

• Evaluate and integrate various workflows and protocols to make informed clinical decisions.

• Facilitate cross-team communication, addressing questions, escalations, processes, and protocols.

• Assess member clinical scenarios against medication policies and either approve or escalate cases to a Pharmacist for denial.

• Identify when medications require internal or external review.

• Liaise with selected external stakeholders to secure approvals for drugs with financial limits.

⛳️ Requirements

• High School diploma or GED or equivalent relevant work experience.

• A valid Pharmacy Technician license is mandatory.

• 2-4 years of experience as a Pharmacy Technician is required.

• At least 2 years of experience in prior authorization review, specifically on the approval side at a PBM or health plan, is essential.

• Proficiency in Mac, MS Office, and G-Suite is required.

• Strong critical thinking skills to navigate intricate customized benefit plans and make sound clinical judgments.

• Excellent active listening and conversational speaking abilities, demonstrating a high level of empathy.

• Capacity to multitask, prioritize, and manage time effectively.

• Ability to communicate clearly and convey complex information to members, clients, pharmacies, providers, and internal teams.

• Aptitude for working accurately within protocols and adhering to proper escalation processes.

🏝️ Benefits

• Time off programs

• Medical insurance

• Dental insurance

• Vision insurance

• Mental health support

• Paid parental leave

• Life insurance

• Disability insurance

• 401(k)

• May be eligible for bonuses, commissions, or equity