This role is a 3 month contract position.
Role Summary
The Clinical Operations Technician serves as the essential link between our Patient Support Team and the final delivery of prescription services. This role requires not only technical mastery of prescription processing but also the ability to translate complex prescription and order-level hurdles into clear, actionable updates for internal and external stakeholders.
Ideal Candidate Profile
The ideal candidate demonstrates an uncompromising 100% focus on optimizing the patient’s experience with PhilRx. They are a critical thinker and natural problem-solver, capable of easily and quickly researching and understanding the root cause of an issue. Beyond resolving immediate barriers to affordable, timely medication, our team focuses on long-term strategies to improve outcomes for all patients facing similar challenges. The ideal candidate for this role is a self-starting, results-oriented professional who balances clinical precision with a sense of urgency, utilizing clear communication and resourceful problem-solving to drive long-term patient adherence rather than just completing isolated tasks.
Key Responsibilities
Conduct thorough research on order and ticket history to recommend the best resolution that aligns with department guidelines.
Ensure all Service Level Agreements (SLAs) are met.
Contact relevant stakeholders to resolve issues that require cross functional collaboration that may impact a successful patient experience
Build strong internal and external rapport, maintaining positive customer and partner relationships.
Review and respond to internal escalation requests in a timely and accurate manner
Proactively initiate, troubleshoot, and resolve PAs and appeals via vendor portals; analyze determination trends to provide valuable insights for patient education.
Serve as the expert liaison between prescribers, insurance payers, and partner pharmacies, translating technical hurdles into actionable solutions that ensure patient access to therapy.
Partner closely with Customer Support to provide clear, jargon-free updates and documentation in our operating systems, ensuring the team has the patient-ready insights needed to support the patient’s journey.
Efficiently navigate multiple software systems and vendor portals with a self-starter mindset, maintaining the flexibility to prioritize tasks based on clinical urgency.
Investigates complex claim rejections and partners with payers and pharmacies to diagnose root causes and establish and execute a clear resolution pathway that is in accordance with regulatory requirements and manufacturer business rules
Act as the primary technical "fixer" for orders falling outside standard workflows, resolving obstacles such as insurance exceptions, pharmacy rejections, failed transfers, and state-specific shipping regulations.
Required Qualifications
Licensed Pharmacy Technician in your state of residence
Experience: Minimum 3 years of professional pharmacy technician or prior authorization experience
Core Skills:
Proven abilities in complex problem-solving and critical thinking.
Highly resourceful, detail-oriented, and capable of seeing complex issues through to completion.
Demonstrated adaptability to swift program and process changes.
Technical Knowledge:
Familiarity with Zendesk, Phil Dashboard, Phil organization structure, and processes.
Good general understanding of computers, hardware, networks, and related technology.
Internal Candidates (Additional Requirements):
Minimum 3 months of tenure with Phil.
Consistent history of great attendance.
Average performance scores of 95% QA
Schedule
Standard Work Days: Monday – Friday.
Availability: Overtime (OT) and holiday work may be required.
Shift Schedule (Pacific Time): Options include 6:00 AM – 3:00 PM, 7:00 AM – 4:00 PM, or 8:00 AM – 5:00 PM
Pay Range