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Full-Time

Patient Access Programs Operations Specialist

Posted on 9/27/2024

SmithRx

SmithRx

201-500 employees

Pharmacy benefit management with transparent pricing

Enterprise Software
Healthcare

Mid

Lehi, UT, USA

Category
Quality Control & Compliance
Supply Chain Management
Operations & Logistics
Required Skills
Communications
Salesforce
Excel/Numbers/Sheets
Requirements
  • High School diploma
  • 2+ yrs of experience in healthcare or health systems operations function
  • Proficiency in Mac, MS-Office, G-Suite
  • Proficiency in Excel and Google Sheets
  • Experience using Salesforce Service Cloud or other CRM tool is a plus
  • High attention to detail
  • Excellent verbal and written communication skills
  • Self-starter with ability to multitask, prioritize, and manage time effectively
  • Ability to organize and prioritize multiple deadlines and work independently, define problems as they arise, and work through them.
  • The ability to make decisions, suggestions, and solve problems using sound, inclusive reasoning and judgment.
  • Ability to work independently as well as part of an extended, cross-functional team
  • Passion for helping people
  • Passion for delivering high quality results
Responsibilities
  • Conduct audits on program builds across adjudication platforms
  • Accurately maintain the program database updated and current based on business needs
  • Assist with aggregating data for Patient Access program billing, and invoicing
  • Managing and updating program drug lists and spreadsheets
  • Contact/make outbound calls to pharmacies to reprocess claims for medications as needed
  • Execute digital communication outreach campaigns
  • Coordinate incoming emails from pharmacy partners and internal teams with the expectation of resolution
  • Provide exceptional support in daily operations of the Patient Access Programs
  • Special projects, general support other ad hoc duties as assigned

SmithRx operates as a Pharmacy Benefit Manager (PBM) that focuses on managing prescription drug plans for self-insured employers and plan sponsors. The company uses a transparent pricing model called "Pass Through Pricing," where it charges only an administrative fee and passes all rebates from prescriptions directly to clients and their members. This model contrasts with traditional PBMs that often inflate drug prices and retain rebates for profit. SmithRx's clients benefit from a technology platform that utilizes real-time data to improve service delivery, ensuring efficient and high-quality pharmacy benefit management. The company also provides a concierge service to enhance support for both members and clients. By prioritizing transparency, advanced technology, and exceptional customer service, SmithRx aims to simplify pharmacy benefits and maximize value for its clients.

Company Stage

Series C

Total Funding

$98.7M

Headquarters

San Francisco, California

Founded

2016

Growth & Insights
Headcount

6 month growth

7%

1 year growth

31%

2 year growth

242%
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Simplify's Take

What believers are saying

  • SmithRx's recent $60M Series C funding led by Venrock positions the company for significant growth and innovation in the PBM market.
  • The partnership with Banjo Health to revolutionize prior authorization processes demonstrates SmithRx's commitment to leveraging cutting-edge technology for improved efficiency and transparency.
  • SmithRx's collaboration with TheracosBio to offer newly approved diabetes drugs highlights its dedication to providing cost-effective and essential medications to its members.

What critics are saying

  • The PBM market is highly competitive, and SmithRx must continuously innovate to maintain its unique value proposition.
  • Reliance on the 'Pass Through Pricing' model may limit revenue growth compared to traditional PBMs that profit from rebates and hidden fees.

What makes SmithRx unique

  • SmithRx's 'Pass Through Pricing' model ensures complete transparency by passing 100% of rebates to clients, unlike traditional PBMs that profit from hidden fees and inflated drug prices.
  • The company's robust technology platform leverages real-time data to enhance service offerings, setting it apart from competitors who may rely on outdated systems.
  • SmithRx's concierge service provides exceptional support to both members and customers, further distinguishing it from other PBMs that may lack personalized customer care.
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