phil - Pharmacy Technician – Prescription Routing & Claims Support
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Requirements
• Pharmacy Technician License in the state of residence(required) • PTCB certification (preferred) • Minimum 1 year of pharmacy technician experience, preferably in a Specialty, Mail Order, PBM (with Manufacturer and Insurance troubleshooting experience) or Retail setting. • Working Knowledge of • Insurance claim rejections (e.g., Reject 50/40, DUR codes, etc.) • Prior authorizations, override codes, and split billing scenarios • ICD-10 codes and drug classifications • FSA/HSA card restrictions and processing nuances • Routing tools and reroute resolution logic • Ability to work efficiently and with attention to detail, especially when handling complex re-routes • Strong written documentation and case management skills
Responsibilities
• Troubleshooting electronic, faxed, and verbal prescriptions via routing to appropriate channels into pharmacy systems • Review and update patient insurance using payer portals and phone resources • Determining appropriate situations for a prior authorization (PAs) need via payer-specific tools; troubleshoot denials and escalations • Utilize reroute best practices for orders falling outside normal workflow, including orders with state changes, insurance exceptions, pharmacy rejections, or failed transfers • Navigate operational platforms (e.g., BestRx, Ops Dash, Partner Dash, RelayHealth, etc.) and vendor systems effectively • Follow reroute protocols for specific tags including: non-contracted pharmacies, state shipping changes, PP send-backs, transfer not received, and more • Proactively document process notes with clear routing details, claim updates, and actions taken • Communicate with partner pharmacies, provider offices, and insurance carriers to resolve issues or clarify documentation • Collaborate with At-Risk, Partner Management, and PPM teams to escalate or flag orders based on system outages, stock issues, or policy refusals • Maintain productivity in the Reroute queue even during extended call hold times (e.g., multitask during insurance calls) • Ensure all patient, prescriber, and partner communications are clear, professional, and aligned with Phil’s standards of care
Benefits
• $21 – $25 per hour • Upload your resume here to autofill key application fields. • Drop your resume here! • Parsing your resume. Autofilling key fields... • or drag and drop here • Hourly Pay Expectation? • I prefer not to answer • Another Gender Identity • Heterosexual / straight • Asian or Asian American • Black or African American • Hispanic or Latine • Indigenous or Native American • Native Hawaiian or Other Pacific Islander • Person with disability • Refugee or immigrant • None of the above • Decline to self-identify • Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. • Hispanic or Latino • White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. • White • Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. • Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. • Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. • Asian • American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. • American Indian or Alaska Native • Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races. • Two or More Races • Hispanic or Latino • White (Not Hispanic or Latino) • Black or African American (Not Hispanic or Latino) • Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) • Asian (Not Hispanic or Latino) • American Indian or Alaska Native (Not Hispanic or Latino) • Two or More Races (Not Hispanic or Latino) • I identify as one or more of the classifications of protected veteran listed above • I am not a protected veteran
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