Remote Pharmacy PA Specialist (Medicare Focus)

Actalent; United States; Teletrabalho; USD 28 000 - 32 000; Tempo integral

Resumo da oferta

Actalent is hiring a Remote MedPharma Pharmacy Technician to process and review Medicare and Medicaid prior authorizations. The role centers on intake, data accuracy, and clinical determinations in a fully remote, HIPAA-compliant environment.

You will handle intake setup, route cases to reviewers, and perform technical reviews to decide on approvals or denials. Strong data entry, insurance interpretation, and customer service are essential.

Qualificações

• Active Pharmacy Technician certification (CPhT) with experience as a Pharmacy Technician.
• Hands-on experience in managed care or similar environment with insurance, claims, and coverage determinations.
• Experience in pharmacy setting with familiarity in medication workflows and prior authorization processes.

Responsabilidades

• Process MedPharma prior authorizations for Medicare and Medicaid (primarily Medicare) according to procedures.
• Set up prior authorization cases in internal systems with accurate data entry.
• Route intake cases to review team and perform technical reviews when trained.
• Determine medication coverage decisions (approve, deny, or partial) based on criteria.
• Read insurance documents, SOPs, and medical documents to determine eligibility.
• Make clinical determinations on approvals/denials based on information and policies.
• Maintain HIPAA-compliant data accuracy for cases and patient information.
• Provide telephone-based customer service for prior authorizations and coverage decisions.

Conhecimentos

CPhT Certification

Managed Care Experience

Prior Authorization

Data Entry

Customer Service

Remote Work Experience

HIPAA Compliance

Insurance Knowledge

Phone Support

Descrição da oferta de emprego

Actalent is hiring a Remote MedPharma Pharmacy Technician to process and review Medicare and Medicaid prior authorizations. The role centers on intake, data accuracy, and clinical determinations in a fully remote, HIPAA-compliant environment.

You will handle intake setup, route cases to reviewers, and perform technical reviews to decide on approvals or denials. Strong data entry, insurance interpretation, and customer service are essential.