Who We Are:
DisclosedRx is a rapidly growing Pharmacy Benefit Management (PBM) company, dedicated to providing comprehensive services for self-funded employer prescription benefit plans. Our focus is on ensuring seamless access to medications while delivering cost savings through innovative programs. We are a dynamic, forward-thinking company with ambitious growth targets, and we believe assembling a team of exceptional professionals is the key to our success.

At DisclosedRx , ethics and honesty are the foundations of our long-term success. Our core values guide us in making a positive impact in the industry and ensuring our clients' and employees' success.

Job Overview:
The Prior Authorization (PA) Technician supports DisclosedR x members by ensuring that prior authorization requests are processed accurately and in a timely manner. This role involves handling inquiries related to prior authorizations, conducting outreach to providers, and collaborating closely with the clinical pharmacist. The PA Technician plays an essential role in maintaining access to clinically appropriate medications for members while managing cost-saving initiatives.

Key Responsibilities:

• Review and process prior authorization requests based on insurance plan coverage guidelines and medical necessity criteria.
• Collaborate with healthcare providers and internal teams to obtain required documentation for prior authorization requests.
• Document all prior authorization requests, interactions, and decisions comprehensively in the internal database.
• Communicate insurance coverage requirements and plan details to providers and members.
• Educate members on their coverage options, including medication alternatives and formulary compliance.
• Respond to inquiries from members, healthcare providers, and pharmacies regarding prior authorization requirements, status updates, and insurance benefits.
• Facilitate the resolution of issues related to medication approvals or denials.
• Ensure compliance with HIPAA and other regulatory requirements when handling member information.
• Generate determination letters or communications for prior authorization approvals or denials.
• Assist in developing and refining workflows to enhance efficiency in processing prior authorizations.
• Support ongoing training and updates on prior authorization policies and insurance procedures for other team members.
• Handle appeals and denials by providing detailed explanations to members and providers, ensuring clarity around the appeals process.
• Assist with special projects or additional tasks as assigned by management to improve prior authorization processes or member experiences.

Who We Are Looking For:
The successful candidate will be detail-oriented and organized, with strong problem-solving and customer service skills. They must have a solid understanding of prior authorization processes and the ability to handle complex insurance inquiries.

Preferred Experience Includes:

• Licensed Pharmacy technician required with 1-2 years of experience in an insurance, pharmacy, or healthcare-related role, with knowledge of prior authorization processes
• Certified Pharmacy Technician (CPhT) preferred
• 1-2 years of experience in an insurance, pharmacy, or healthcare-related role, with knowledge of prior authorization processes.
• Strong understanding of insurance policies, formulary management, and medical terminology.
• Excellent problem-solving and customer service skills, with the ability to handle complex insurance inquiries.
• Proficiency in using healthcare management software and internal databases.
• Strong attention to detail, with the ability to manage multiple tasks and prioritize effectively.

What We Offer:
This is a unique opportunity to join a growing company with tremendous potential. We offer competitive compensation and a fully remote work environment, providing flexibility and work-life balance. DisclosedRx is committed to investing in your professional development through comprehensive training, mentoring, and career advancement opportunities.

If you are passionate about supporting members through the prior authorization process and ensuring access to necessary medications, we encourage you to apply and join our team.