Remote Pharmacy PA Specialist

Actalent; Houston (TX); Remote; USD 28.000 - 32.000; Vollzeit

Benefits dieser Stelle

Medical, dental & vision coverage

401(k) Retirement Plan

Paid time off

Zusammenfassung

Actalent is seeking a certified Pharmacy Technician to support patients by managing prior authorizations for Medicare and Medicaid prescriptions in a fully remote role. You will handle intake and technical review, using your pharmacy and managed care experience to determine coverage and ensure timely access to medications.

The position combines data entry, clinical review, and phone-based customer service, working independently within a structured, supportive remote team.

Qualifikationen

• Active Pharmacy Technician certification (such as CPhT) with eligibility to perform pharmacy technician duties.
• Pharmacy technician experience, preferably in a managed care or similar environment.
• Hands-on experience with managed care or pharmacy benefit processes, including prior authorization workflows.

Aufgaben

• Process prior authorization (PA) requests for Medicare and Medicaid patients, with a primary focus on Medicare cases.
• Perform intake of MedPharm prior authorization requests by gathering required information and accurately setting up PA cases in internal systems.
• Route completed intake cases to the review team and, once trained, perform both intake and technical review functions as needed.
• Conduct technical review of PA cases by carefully reading and interpreting criteria, SOPs, insurance documents, and medical records.
• Make clinical determinations on medication coverage, including whether a prescription should be approved, denied, or covered under specific conditions.
• Document all decisions clearly and accurately in the appropriate systems, ensuring compliance with internal policies and regulatory requirements.
• Use strong data entry skills to maintain accurate, up-to-date records for each prior authorization case.
• Provide customer service over the phone, handling inbound and outbound calls related to prior authorizations and coverage determinations.
• Control and guide conversations with callers, redirecting as needed to obtain required information and maintain a professional, efficient interaction.
• Collaborate with team members in a remote environment to ensure timely processing of cases and equitable distribution of rotating holiday coverage.
• Follow all HIPAA and confidentiality requirements when handling patient information and working in a remote setting.
• Participate in training and ongoing development to expand from intake responsibilities into full technical review capabilities.
• Adhere to established schedules, including evenings, weekends, and rotating holiday coverage.
• Utilize computer systems and software tools efficiently to manage workflow, review documentation, and communicate with colleagues.

Kenntnisse

CPhT certification

Pharmacy tech experience

Managed care knowledge

Data entry accuracy

Phone-based service

Remote work capable

Reading comprehension

Clinical determinations

Multiple systems

Independent work

Jobbeschreibung

Actalent is seeking a certified Pharmacy Technician to support patients by managing prior authorizations for Medicare and Medicaid prescriptions in a fully remote role. You will handle intake and technical review, using your pharmacy and managed care experience to determine coverage and ensure timely access to medications.

The position combines data entry, clinical review, and phone-based customer service, working independently within a structured, supportive remote team.