Prior Authorization Pharmacy Technician – Seasonal
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Job Description
Prior authorization pharmacy technician supporting SmithRx’s technology-driven PBM drug access platform. Reviewing coverage requests, coordinating clinical reviews, and guiding timely medication access.
Responsibilities:
- Assist members, providers, pharmacies, and internal SmithRx teams in navigating prescription complexities and timely medication coverage
- Verify eligibility and drug coverage under plan benefit designs for appropriate claims processing
- Triage clinical review processes for prior authorization requests according to established protocols
- Review prior authorization requests using criteria, claims history, and plan benefit rules
- Conduct prescriber and pharmacy outreach to verify and gather required information
- Organize and prioritize requests for timely prior authorization case management
- Build and adjust authorizations in the claim adjudication system
- Navigate drug products and formulations and perform basic calculations to monitor accurate claims adjudication
- Assess and synthesize multiple workflows and protocols to make sound clinical decisions
- Coordinate cross-team outreach, questions, escalations, processes, and protocols
- Evaluate member clinical situations against medication policies and approve or triage cases to a Pharmacist for denial
- Determine when medications require internal or external review
- Contact selected external stakeholders for approval on drugs with dollar limits
Requirements:
- High School diploma or GED or equivalent work experience
- Active Pharmacy Technician license required
- 2-4 years of experience as a Pharmacy Technician
- 2+ years of experience in prior authorization review, specifically working on the approval side at a PBM or health plan, required
- Proficiency in Mac, MS Office, and G-Suite required
- Critical thinking to navigate complex customized benefit plans and make sound clinical decisions
- Active listening and conversational speaking skills, with a high degree of empathy
- Ability to multitask, prioritize, and manage time effectively
- Ability to communicate clearly and present complex information to members, clients, pharmacies, providers, and internal teams
- Ability to work accurately within protocols and follow appropriate escalation pathways
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
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