Remote Pharmacy Technician — Prior Authorization Specialist

SmithRx; United States; Remote; USD 25,000 - 36,000; Part time

Job summary

SmithRx is seeking a Pharmacy Technician to support members, providers, and pharmacies in navigating prescription coverage and prior authorizations. The role emphasizes adherence to plan designs and clinical criteria while collaborating with SmithRx teams.

You will triage and process prior authorization requests, verify coverage, and perform calculations to ensure accurate claims adjudication in a fast-paced contract environment. Strong communication is essential.

Qualifications

• High School diploma or GED or equivalent work experience.
• Active Pharmacy Technician license required.
• 2–4 years of experience as a Pharmacy Technician.
• Experience in prior authorization review (PBM/health plan) preferred.
• Proficiency in Mac, MS Office, G-Suite required.
• Critical thinking to navigate complex benefit plans for clinical decisions.
• Active listening and empathy in client interactions.
• Self-starter with ability to multitask and manage time effectively.
• Clear communication to members, clients, pharmacies, and teams.
• Ability to follow protocols and escalation pathways.

Responsibilities

• Verify eligibility and drug coverage under plan benefit design to determine claims processing.
• Triaging clinical review for prior authorization requests per established protocols.
• Review of prior authorization requests using criteria, history, and plan rules; outreach as needed.
• Organize and prioritize multiple requests to ensure timely case management.
• Build and adjust authorizations within the claim adjudication system.
• Utilize pharmacy technician experience to navigate drug products and calculations.
• Assess multiple workflows to make sound clinical decisions.
• Coordinate outreach and address questions/escalations across teams.
• Evaluate clinical situations against policies and decide on approval or denial by Pharmacist.
• Determine when external review is needed by synthesizing protocols.
• Reach out to external stakeholders for approvals on drugs with dollar limits.

Skills

Critical thinking

Active listening

Empathy

Time management

Multi-tasking

Clear communication

Self-starter

Team collaboration

Education

High School diploma or GED

Active Pharmacy Technician license

Tools

Mac

MS Office

G-Suite

Job description

SmithRx is seeking a Pharmacy Technician to support members, providers, and pharmacies in navigating prescription coverage and prior authorizations. The role emphasizes adherence to plan designs and clinical criteria while collaborating with SmithRx teams.

You will triage and process prior authorization requests, verify coverage, and perform calculations to ensure accurate claims adjudication in a fast-paced contract environment. Strong communication is essential.