Remote Pharmacy Access Specialist

Actalent; Cary (NC); On-site; USD 30,000 - 33,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

Life Insurance

Job summary

Actalent is seeking a Pharmacy Technician to support patients and providers by coordinating access to specialty and biologic medications. You will lead benefits investigations, prior authorizations, and financial assistance navigation, ensuring timely therapy start and clear patient communication.

The role emphasizes HIPAA compliance, accurate documentation in pharmacy management systems, and collaboration with payers, providers, and HUB services. This contractor role is based in Cary, NC.

Qualifications

• Pharmacy background with experience in specialty and biologic therapies.
• Customer service experience, particularly in a healthcare or pharmacy setting.
• Experience with prior authorizations, including benefits investigation and coverage verification.
• Ability to recognize and effectively communicate about various insurance types and their appropriate use.
• Proficiency in data entry with strong attention to detail and accuracy.
• Ability to enter all communication and documentation in pharmacy or biologics management information systems.
• Skill in appropriately processing pharmacy claims and interpreting claim responses.
• Strong verbal and written communication skills for interacting with patients, providers, payers, and internal teams.
• Ability to manage inbound calls from patients, clients, physicians, and payors regarding patient updates and services provided.
• Experience identifying and reporting adverse events and product complaints to clinicians.
• Capacity to manage and respond to internal written communications via chat or email.
• Requires 1+ years of related experience in a pharmacy, healthcare, or prior authorization environment.
• Registered Pharmacy Technician credential required.
• 1–2 years of experience specifically with prior authorizations and pharmacy-related customer service.

Responsibilities

• Conduct comprehensive benefits investigations for biologic and specialty therapies, ensuring accurate coverage verification.
• Verify insurance eligibility, coverage limitations, deductible and co-pay amounts, and specialty pharmacy requirements.
• Identify prior authorization, step therapy, quantity limit, and reauthorization needs based on payer policies.
• Gather and organize clinical documentation required for prior authorization submissions.
• Communicate prior authorization criteria, required forms, and next steps clearly to provider offices.
• Track prior authorization status closely and provide timely updates to patients, providers, and internal teams.
• Assist with written and verbal appeals when coverage is denied, supporting providers with necessary documentation.
• Screen patients for co-pay assistance, foundation grants, and manufacturer-sponsored financial assistance programs.
• Help patients complete required financial assistance paperwork and follow up on application status to ensure continuity of care.
• Collaborate with internal and external stakeholders to align funding with payer requirements and program guidelines.
• Provide clear, compassionate communication to patients regarding coverage status, delays, and next steps.
• Educate patients on therapy onboarding timelines and available support program resources.
• Manage inbound and outbound calls with professionalism, accuracy, and empathy, including calls from patients, physicians, payers, and other partners.
• Collaborate with provider offices to obtain missing documentation, signatures, and clinical details needed to move therapy forward.
• Communicate with specialty pharmacies regarding prescriptions and triage steps, ensuring accurate information flows between all parties to avoid delays.
• Triage prescriptions to preferred pharmacies or HUB providers when the dispensing pharmacy is unable to serve the patient.
• Enter all communication and documentation in the designated management information system with a high level of accuracy.
• Appropriately process pharmacy claims in the management information system and recognize and interpret pharmacy claim responses.
• Maintain detailed, accurate progress notes and documentation to support audits, URAC requirements, and internal quality assurance expectations.
• Adhere to HIPAA guidelines and internal compliance standards at all times.
• Recognize and effectively communicate about different insurance types and when each type would be utilized.
• Manage and respond to internal written communications and requests received via chat or email.
• Identify and report adverse events and product complaints to clinicians in accordance with established procedures.
• Assist with projects such as yearly insurance reverification and other operational initiatives as needed.
• Meet productivity and quality benchmarks, including turnaround times for benefits verifications and prior authorizations, quality audit standards, and call handling metrics when applicable.
• Support cross-functional teams as needed based on business workload and service level requirements.
• Perform other related duties as assigned.

Skills

Pharmacy background

Customer service

Prior authorizations

Insurance types

Data entry

Pharmacy systems

Pharmacy claims

Communication skills

Call handling

Adverse events reporting

Internal communications

Experience in pharmacy environment

Pharmacy technician credential

Prior authorizations experience

Education

Associate degree or equivalent

Certified Pharmacy Technician (CPhT) credential

Tools

Caretend

AssistPoint

Job description

Actalent is seeking a Pharmacy Technician to support patients and providers by coordinating access to specialty and biologic medications. You will lead benefits investigations, prior authorizations, and financial assistance navigation, ensuring timely therapy start and clear patient communication.

The role emphasizes HIPAA compliance, accurate documentation in pharmacy management systems, and collaboration with payers, providers, and HUB services. This contractor role is based in Cary, NC.