Pharmacy Technician, Prior Authorization

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.  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 of: Do the right thing. Especially when it’s hard. Embrace the challenge. Build bridges and lift up your colleagues. Job Summary: You will assist members, providers, pharmacies, and the internal SmithRx teams to navigate complexities of prescriptions to guide timely coverage of clinically appropriate, cost effective medication therapy in accordance with plan benefit design and clinical criteria for coverage.  This may involve coordination of clinical review cases, checking coverage and plan rules, verification of submitted information, pharmacy and provider outreach, review of prior authorization requests within established protocols, and assisting to triage and troubleshoot questions and escalations. What you will do: Verify eligibility and drug coverage under the plan benefit design to determine appropriate claims processing Responsible for triaging the process of clinical review for prior authorization requests at different levels as per established protocols Review prior authorization and similar requests under protocol using prior authorization criteria, claims history and plan benefit rules, including prescriber/pharmacy outreach to verify and gather complete required information Organize and prioritize multiple requests internally and externally to ensure timely prior authorization case management across the clinical review team. Build and adjust authorizations under protocol within the claim adjudication Use pharmacy technician experience to navigate drug products, formulations, and perform basic calculations to check and monitor accurate claims adjudication. Work across teams to coordinate outreach, address questions/escalations, and help guide processes and protocols for timely and appropriate medication coverage. Serve as coach and mentor to junior members of the team in the clinical review process What you will bring to SmithRx: High School diploma or GED or equivalent work experience Active Pharmacy Technician license required 5+ years of experience as a Pharmacy Technician Proficiency in Mac, MS Office, G-Suite required 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. Flexibility and ability to adapt to changes and updates to processes and protocols Demonstrate accurate drug product/dose calculations for appropriate claim adjudication and knowledge of general pharmacy and drug product information for the prescription filling process What SmithRx Offers You:   Competitive Pay Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, Life insurance  Discretionary Time Off  401(k) Retirement Savings Program  Flexible Spending Benefits  Commuter Benefits  Paid Parental Leave benefits Professional development and training opportunities