Job Description:

• 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

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 - Medicaid/Medicare Experience - 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

Benefits:

• Competitive compensation and full benefits (medical, dental, vision, etc.)
• 401(k)
• Hybrid work model after 90 days (in-office collaboration & remote flexibility)
• Collaborative, mission-driven team culture focused on innovation and patient care