Company Overview

Position Overview

Primary Responsibilities

• Troubleshooting electronic, faxed, and verbal prescriptions via routing to appropriate channels into pharmacy systems
• Review and update patient insurance using payer portals and phone resources
• Determining appropriate situations for a prior authorization (PAs) need via payer-specific tools; troubleshoot denials and escalations
• Utilize reroute best practices for orders falling outside normal workflow, including orders with state changes, insurance exceptions, pharmacy rejections, or failed transfers
• Navigate operational platforms (e.g., BestRx, Ops Dash, Partner Dash, RelayHealth, etc.) and vendor systems effectively
• Follow reroute protocols for specific tags including: non-contracted pharmacies, state shipping changes, PP send-backs, transfer not received, and more
• Proactively document process notes with clear routing details, claim updates, and actions taken
• Communicate with partner pharmacies, provider offices, and insurance carriers to resolve issues or clarify documentation
• Collaborate with At-Risk, Partner Management, and PPM teams to escalate or flag orders based on system outages, stock issues, or policy refusals
• Maintain productivity in the Reroute queue even during extended call hold times (e.g., multitask during insurance calls)
• Ensure all patient, prescriber, and partner communications are clear, professional, and aligned with Phil’s standards of care

About You

• You thrive in a fast-paced, evolving startup environment and remain composed under pressure
• You're passionate about helping patients access necessary medications
• You are tech-savvy, comfortable toggling between multiple software systems and navigating insurance workflows
• You’re a strong communicator, able to write succinct internal notes and speak clearly with external stakeholders
• You’re self-driven but collaborative; you seek clarity, ask smart questions, and take initiative
• You take pride in accuracy and process adherence, especially when rerouting orders or resolving insurance mismatches

Qualifications

• Arizona or Ohio Pharmacy Technician License (required)
• PTCB certification (preferred)
• Minimum 1 year of pharmacy technician experience, preferably in a Specialty, Mail Order, PBM (with Manufacturer and Insurance troubleshooting experience) or Retail setting.

Working Knowledge of

• Insurance claim rejections (e.g., Reject 50/40, DUR codes, etc.)
• Prior authorizations, override codes, and split billing scenarios
• ICD-10 codes and drug classifications
• FSA/HSA card restrictions and processing nuances
• Medicaid/Medicare Experience
• Routing tools and reroute resolution logic
• Ability to work efficiently and with attention to detail, especially when handling complex re-routes
• Strong written documentation and case management skills

Why Join Phil

• Ground-floor opportunity in one of the fastest-growing health-tech startups
• Help modernize prescription access for real-world impact
• Competitive compensation and full benefits (medical, dental, vision, etc.)
• 401(k)
• Hybrid work model after 90 days (in-office collaboration & remote flexibility)
• Collaborative, mission-driven team culture focused on innovation and patient care