Remote Medicare/Medicaid PA Pharmacy Tech

Actalent; Nashville (TN); Remote; USD 28,000 - 32,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) retirement plan

Life Insurance

Disability insurance

Health Savings Account

Commuter benefits

Paid time off

Job summary

Actalent is seeking a Remote Pharmacy Technician to support Medicare and Medicaid patients by processing and reviewing prior authorization requests in a fully remote environment. You will intake requests, perform technical reviews, and make coverage determinations based on criteria and SOPs.

This contract-to-hire role is based out of Nashville, TN, with pay of $20.00-$23.00 per hour. You will work from home, handle calls from patients and providers, ensure HIPAA compliance, and participate in

Qualifications

• Active pharmacy technician certification (CPhT) required.
• Hands-on experience as a pharmacy technician, preferably in managed care or prior authorization.
• Experience with managed care and pharmacy operations including Medicare/Medicaid.
• Prior authorization experience including intake, review, or claims-related activities.
• Strong data entry skills with high accuracy and attention to detail.
• Proficiency with computer systems required for remote work and prior authorization processing.
• Customer service experience over the phone including inbound/outbound calls.
• Ability to control conversations and redirect discussions professionally.
• Capable of remote independent work while meeting performance expectations.
• Solid understanding of pharmacy terminology and clinical concepts related to coverage and eligibility.

Responsibilities

• Process intake of MedPharm prior authorization requests and set up cases in internal systems.
• Route intake cases to review team and perform technical review of prior authorization cases.
• Review cases to determine medication coverage and make approval/denial decisions.
• Read and interpret coverage criteria, SOPs, and documents to assess eligibility.
• Make clinical determinations on approvals or denials based on guidelines.
• Enter data related to claims, prior authorizations, and patient information.
• Provide professional phone support to patients and providers on status and requirements.
• Direct conversations to maintain focus and provide clear information.
• Work independently in a remote setting, maintaining productivity and quality.

Skills

CPhT

Pharmacy tech experience

Managed care

Prior authorization

Data entry accuracy

Remote work systems

Phone customer service

Call handling

Independent work

Pharmacy terminology

Job description

Actalent is seeking a Remote Pharmacy Technician to support Medicare and Medicaid patients by processing and reviewing prior authorization requests in a fully remote environment. You will intake requests, perform technical reviews, and make coverage determinations based on criteria and SOPs.

This contract-to-hire role is based out of Nashville, TN, with pay of $20.00-$23.00 per hour. You will work from home, handle calls from patients and providers, ensure HIPAA compliance, and participate in