Prior Authorization Technician Jobs

Location: Remote

About Capital Rx

Capital Rx is a next generation pharmacy benefits manager, overseeing prescription benefit plans on behalf of employers, unions, and government entities. Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change. Through our platform approach, Capital Rx delivers data-driven insights and actionable strategies that reduce costs, while improving patient outcomes. Our commitment to innovation, technology and service is the reason why Capital Rx is among the fastest-growing PBMs in the country.

Position Responsibilities:

• Identify, document, and escalate provider concerns to the appropriate internal team including various members of the Prior Authorization Team
• Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.
• Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines
• Review and analyze pharmacy claims data for proactive outreach and intervention.
• Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review
• Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders.
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies
• Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
• Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment

Required Qualifications:

• National Certified Pharmacy Technician (CPhT) license, preferred
• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment
• High school diploma or the equivalent; Associate’s or bachelor’s degree is preferred
• Excellent communication, writing, and organizational skills
• Ability to multi-task and collaborate in a team with shifting priorities
• 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting
• Experience handling prior authorization requests/understanding of prior authorization requirements required

Base Salary: $45,000 - $55,000

This range represents the low and high end of the anticipated base salary range for the NY - based position. The actual base salary will depend on several factors such as: experience, knowledge, and skills, and if the location of the job changes.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.