Contract Coverage Review Technician - Contract up to 120 days
About The Position
Prescryptive Health is a healthcare technology company delivering solutions that empower consumers. Prescryptive’s secure, mobile-first products connect consumers, pharmacists, and employers, ultimately providing people with the information they need to make informed decisions and take control of their health. To learn more about Prescryptive Health, visit Prescryptive.com. About this role The Contract Coverage Review Technician supports the prior authorization and coverage determination process to ensure timely, accurate, and compliant decisions within Prescryptive’s pharmacy benefit management (PBM) operations. This role enables efficient medication access for members by executing PA reviews, maintaining documentation standards, and collaborating across teams to resolve coverage issues. The technician contributes to operational excellence, regulatory compliance, and continuous process improvement, including the adoption of automation and AI-enabled tools. This is a full-time contract roles (40 hours per week, up to 120 days)
Requirements
- 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.
Nice To Haves
- Associate’s degree or higher in healthcare or a related field.
- Experience in a clinical call center or PBM operations environment.
Responsibilities
- 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.
Benefits
- This is a contract role and therefore not eligible for Prescryptive employee benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
