Prescryptive Health, Inc. · 1 week ago
Coverage Review Technician (Contract)
United States
Contract
Remote
Entry, Mid Level
$28/hr - $32/hr
2+ years expPrescryptive Health is a healthcare technology company delivering solutions that empower consumers. The Contract Coverage Review Technician supports the prior authorization and coverage determination process within Prescryptive’s pharmacy benefit management operations, ensuring timely and compliant decisions to facilitate medication access for members.
Health CareInformation Technology
Responsibilities
Execute accurate and timely review and processing of prior authorization (PA) requests using established clinical criteria, PBM guidelines, and system protocols
Maintain accurate, auditable records of all determinations and communications to meet compliance and quality standards
Partner with prescribers, pharmacists, and internal teams to resolve PA-related issues and ensure positive member outcomes
Achieve production and accuracy metrics while identifying opportunities to improve workflow efficiency through automation or process optimization
Review and process PA requests in alignment with clinical and operational criteria
Communicate with provider offices to obtain necessary or clarifying information through appropriate channels (phone, fax, or electronic systems)
Enter determinations, overrides, and documentation accurately within PA and PBM platforms
Maintain compliance with privacy, security, and regulatory requirements
Collaborate with pharmacists, account managers, and customer support teams to address PA-related inquiries or escalations
Identify recurring issues, data inconsistencies, or system barriers, and escalate for resolution
Support improvement initiatives including the implementation of automation and AI-enabled tools that enhance workflow accuracy and turnaround
Consistently meet or exceed established productivity and quality standards
Qualification
Required
Active Pharmacy Technician License
High school diploma or GED
2 years of experience in pharmacy operations, PBM, or related healthcare administration
1+ years handling prior authorizations in a PBM, health plan, or clinical pharmacy setting
Strong understanding of pharmacy operations and PBM workflows
Proficiency in Microsoft Office Suite and PBM claims systems
Experience with prior authorization process and using prior authorization platforms and managing clinical documentation
Demonstrated expertise in HIPAA compliance and deep understanding of evolving prior authorization (PA) regulations and electronic PA standards
Proven track record of enforcing the highest standards of privacy, security, and regulatory compliance in every aspect of work
Proven experience leveraging AI and automation technologies to optimize coverage review and streamline decision-making processes
Effective written and verbal communication skills
Customer service orientation and professionalism in interactions with providers and internal teams
Ability to work independently in a fast-paced, deadline-driven, metric-oriented environment
Excellent attention to detail and organizational skills
Preferred
Associate's degree or higher in healthcare or a related field
Experience in a clinical call center or PBM operations environment
Benefits
This is a contract role and therefore not eligible for Prescryptive employee benefits.
Company
Prescryptive Health, Inc.
Prescryptive is a healthcare technology company transforming the U.S. prescription drug market.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
$26MKey Investors
MorningsidePool Global Partners
2020-08-25Series A· $26M
2019-04-01Seed
Leadership Team
Chris Blackley
Chief Executive Officer & Co-Founder
Kevin Young
Chief Product Officer & Co-Founder
Recent News
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