Job Details

Who is Prescryptive?

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)

What you will do

Key Accountabilities

• Prior Authorization Processing - Execute accurate and timely review and processing of prior authorization (PA) requests using established clinical criteria, PBM guidelines, and system protocols.
• Documentation and Compliance - Maintain accurate, auditable records of all determinations and communications to meet compliance and quality standards.
• Cross-functional Collaboration - Partner with prescribers, pharmacists, and internal teams to resolve PA-related issues and ensure positive member outcomes.
• Quality and Continuous Improvement - Achieve production and accuracy metrics while identifying opportunities to improve workflow efficiency through automation or process optimization.

Position 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.

Minimum 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.

Preferred experience, in addition to minimum requirements

• Associate's degree or higher in healthcare or a related field.
• Experience in a clinical call center or PBM operations environment.

Contract Details:

• Length of Contract: up to 120-day assignment (with potential extension based on business needs)
• Schedule: Must be available to work 8-hour shifts between Monday-Friday, 8:00 a.m.-5:00 p.m.
• Pay Range: $28-32 per hour, commensurate with experience, qualifications, and location.
• Work Arrangement: Remote (U.S.-based); must have reliable internet and a suitable private workspace for confidential calls.
• Equipment: Prescryptive will provide a laptop for the duration of the contract.
• Benefits: This is a contract role and therefore not eligible for Prescryptive employee benefits.

Prescryptive is an Equal Opportunity Employer. Prescryptive does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need.