Remote Medicare PA Tech: Prior Authorization Specialist

Actalent; Detroit (MI); Remote; USD 28,000 - 32,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Plan

Life Insurance

Disability

Health Spending Account

Transportation benefits

Employee Assistance Program

PTO

Job summary

Actalent is seeking a Remote Pharmacy Technician to support Medicare and Medicaid patients by processing and reviewing prior authorizations in a fully remote environment. You will handle intake, apply criteria, and determine whether medications should be approved, denied, or partially covered.

This role emphasizes detailed data entry, familiarity with managed care pharmacy, and professional phone support to patients and providers.

Qualifications

• Active pharmacy technician certification (CPhT).
• Hands-on experience as a pharmacy technician, preferably in a managed care or prior authorization setting.
• Experience with managed care and pharmacy operations, including Medicare/Medicaid populations.
• Demonstrated 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 and applications required for remote work and prior authorization processing.
• Customer service experience over the phone, including handling inbound and outbound calls.
• Ability to control conversations, manage difficult calls, and redirect discussions to maintain professionalism and clarity.
• Solid understanding of pharmacy terminology and basic clinical concepts related to medication coverage and eligibility.

Responsibilities

• Process the intake of prior authorization requests and set up pri or authorizations in internal systems.
• Route intake cases to the review team and, once trained, handle technical review of prior authorization cases.
• Review prior authorization cases to determine medication coverage and make approval/denial/partial coverage decisions.
• Read and interpret coverage criteria, SOPs, insurance documents, and medical documentation to assess eligibility.
• Make clinical determinations on whether medications are approved or denied based on guidelines.
• Perform accurate and timely data entry related to claims, prior authorizations, and patient information.
• Provide professional customer service over the phone to patients and providers regarding prior authorization status and requirements.
• Maintain HIPAA and privacy compliance in a remote, closed setting.
• Support rotating holiday coverage and flexible scheduling needs.
• Participate in training and apply new processes and system updates to daily work.

Skills

CPhT certification

Pharmacy technician

Medicare/Medicaid

Prior authorization

Data entry

Remote work

Phone support

HIPAA compliance

Communication skills

Systems proficiency

Job description

Actalent is seeking a Remote Pharmacy Technician to support Medicare and Medicaid patients by processing and reviewing prior authorizations in a fully remote environment. You will handle intake, apply criteria, and determine whether medications should be approved, denied, or partially covered.

This role emphasizes detailed data entry, familiarity with managed care pharmacy, and professional phone support to patients and providers.