Prior Authorization Specialist - Remote
Capsule
About Capsule
Capsule is a new kind of pharmacy. One that is smarter, friendlier, faster, and hand-delivers your medication, same-day, for free. We have a national presence and have raised over $500MM from the best healthcare and technology investors in the world. People succeed in our culture when they are intensely focused on our customers, are energized by accomplishing ambitious goals, and push themselves and their teammates to be their best. If this excites you, we’d love to have you join us.
The ClearRx team at Capsule powers a product designed to streamline and enhance the pharmacy experience for providers and their patients. ClearRx seamlessly supports any pharmacy, any prescription, and any location.
About the Role
As an insurance specialist on the ClearRx team, you will be responsible for providing white-glove service for ClearRx customers by following an efficient prescription workflow, optimizing customer satisfaction, and helping to navigate complex pharmacy issues.
Your responsibilities will include:
Communicate with doctors, customers, and insurance companies to resolve insurance issues.
Understand insurance formularies to support cost-saving alternatives and explore options such as applying coupons to meet customer needs.
Assess and initiate the Prior Authorization (PA) process as needed, ensuring alignment with provider recommendations and customer preferences.
Clearly explain prescription options to customers and providers, prioritizing the best outcome for the customer.
Ensure that coding on claims follow payer guidance and lead to maximum reimbursement by third-party payers.
Requirements
Preferred: You have direct experience working with dermatology-specific medications and insurance processes, including high-cost treatments, specialty medications, and prior authorization workflows commonly associated with dermatological care.
You have or are willing to obtain a New Jersey Technician Registration before start date
You have 2+ years of experience as a pharmacy technician working closely with claims adjudications. PTCB certification preferred, but not required.
You are familiar with industry specific terminology (SIG codes, both brand and generic names of medications)
You have access to a reliable computer with audio and video capabilities, including high-speed internet of at least 100 Mbps
You have flexible availability. Schedules will be set in conversation with hiring managers and may include both weekday and weekend hours or morning, afternoon, and evening shifts - specifically Monday to Friday: 8am - 8pm EST and Saturday to Sunday: 10am - 6pm EST.
You work hard and enjoy the process, combining emotional intuition for a great consumer experience with analytical rigor to improve pharmacy processes, celebrating wins along the way.
What We Offer
Competitive compensation, commensurate with qualifications and experience
Comprehensive benefits package including medical, dental, and vision coverage
The opportunity to work alongside some of the brightest minds in healthcare and technology
The opportunity to execute on a high-impact mission, to build a pharmacy that works for everyone, within a $425 billion pharmacy industry touching 70% of Americans once a month
Capsule is committed to hiring the best team possible to build a pharmacy that works for everyone. We have a diverse set of problems to solve and believe that we need a diverse set of perspectives to deliver the best possible solutions to those problems. We look for talent from a wide range of backgrounds - including but not limited to - race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.