Remote Medicaid Prior-Auth Technician

Actalent; Houston (TX); Remote; USD 25,000 - 36,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

Paid time off

Remote work equipment provided

Job summary

Actalent is seeking a Fully Remote Certified Pharmacy Technician to evaluate Medicaid prior authorization requests in a high-volume call center. The role involves telephone and fax-based processing, detailed documentation, and escalation to pharmacists as needed.

Training is provided and the term begins as a 1-year contract with potential extension or conversion. Candidates should hold an active state license, national certification, and 1+ year of relevant experience.

Qualifications

• High school diploma or GED.
• Active state pharmacy technician registration or license.
• National pharmacy technician certification (PTCB or NHA).
• At least 1 year of experience in a retail or call center pharmacy environment (3+ years preferred).
• Experience with prior authorization processes in a pharmacy or related setting.
• Proficient data entry skills with a high level of accuracy.
• Strong written and verbal communication skills for interacting with healthcare professionals and internal teams.
• Excellent attention to detail and organizational skills.
• Ability to comfortably navigate and work within multiple computer systems and applications at the same time.
• Ability to work independently and maintain productivity in a fast-paced, remote environment.
• Customer service orientation with the ability to handle inquiries and grievances professionally.

Responsibilities

• Evaluate and authorize Medicaid prior authorization requests by telephone using established criteria.
• Determine appropriateness of medications based on guidelines and coverage rules.
• Communicate decisions to physicians and staff clearly and professionally.
• Document all prior authorization outcomes accurately in the pharmacy system.
• Explain criteria, coverage, and formulary alternatives to prescribers and other healthcare professionals.
• Escalate complex cases to a pharmacist with proper procedures.
• Document physician and client inquiries and grievances and provide timely results.
• Review fax-based determinations and maintain SLA timelines.
• Navigate multiple computer systems to research and process requests.
• Participate in training and apply procedures to daily work.
• Work shifts including weekends/holidays and overtime as needed.

Skills

Active state license

National certification

Retail/call center experience

Data entry accuracy

Strong communication

Remote work ability

Education

High school diploma or GED

Job description

Actalent is seeking a Fully Remote Certified Pharmacy Technician to evaluate Medicaid prior authorization requests in a high-volume call center. The role involves telephone and fax-based processing, detailed documentation, and escalation to pharmacists as needed.

Training is provided and the term begins as a 1-year contract with potential extension or conversion. Candidates should hold an active state license, national certification, and 1+ year of relevant experience.