Prior Authorization Pharmacy Technician

Who We Are:

SmithRx is a rapidly growing, venture-backed Health-Tech company.  Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service.  With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.

We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our company values:

• Integrity: Always operate with honesty and transparency so we earn the trust of our clients.
• Courage: Demonstrate the courage needed to take on a broken industry and continuously improve what we offer to optimize health outcomes.
• Together: Foster a collaborative and inclusive environment that values teamwork, respect, and open communication, and encourages creativity and diversity of thought.

Job Summary:

As a Pharmacy Technician at SmithRx, you will play a crucial role in assisting members, providers, pharmacies, and internal teams to navigate the complexities of prescription coverage. You will ensure timely access to clinically appropriate, cost-effective medication therapy, in line with plan benefit design and clinical criteria. Your responsibilities will include coordinating clinical review cases, verifying coverage, performing outreach, reviewing prior authorization requests, and resolving escalations.

In order to be eligible for this contract position, applicants must be based in on of the following states:Arkansas, Arizona, Florida, Georgia, Kansas, Missouri, Ohio, Tennessee, Texas, Utah, Virginia, Wisconsin

This 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. 

What you will do:

• Verify eligibility and drug coverage under the 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.

What you will bring to SmithRx:

• High School diploma or GED or equivalent work experience
• Active Pharmacy Technician license required
• 2+ years of experience 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.