Remote Pharmacy PA Specialist (Medicare/Medicaid)

Actalent; Atlanta (GA); Remote; USD 28,000 - 32,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

Life Insurance

Short and long-term disability

Health Spending Account (HSA)

Transportation benefits

Employee Assistance Program

Time Off/Leave (PTO, Vacation or Sick)

Job summary

Actalent seeks a Remote Pharmacy Technician Prior Authorization Specialist to support Medicare/Medicaid patients by managing PA requests in a fully remote environment. You will handle intake and technical review, using your pharmacy and managed care experience to determine coverage and ensure timely access to medications.

This role combines data entry, clinical review, and phone-based customer service while working independently in a structured, supportive team setting.

Qualifications

• Certified Pharmacy Technician (CPhT) with eligibility to perform duties.
• Experience in managed care or PBM environments.
• Experience with prior authorization workflows and claims.
• Strong data entry accuracy and attention to detail.
• Phone-based customer service experience in healthcare.

Responsibilities

• Process PA requests for Medicare/Medicaid patients, focusing on Medicare.
• Gather information and set up PA cases in internal systems.
• Route intake cases to the review team and perform intake/technical review when trained.
• Conduct technical review by reading criteria, SOPs, insurance docs, and records.
• Make coverage determinations on prescriptions (approve/deny/conditions).
• Document decisions clearly in systems with HIPAA compliance.
• Maintain accurate records through data entry and case management.
• Provide telephone-based customer service for PA and coverage questions.
• Collaborate in a remote team to ensure timely case processing and holiday coverage.

Skills

CPhT Certification

Pharmacy tech experience

Managed care knowledge

Data entry accuracy

Phone-based customer service

Remote work capability

IT/computer skills

Reading/comprehension of SOPs

Tools

MedPharm PA platform

Job description

Actalent seeks a Remote Pharmacy Technician Prior Authorization Specialist to support Medicare/Medicaid patients by managing PA requests in a fully remote environment. You will handle intake and technical review, using your pharmacy and managed care experience to determine coverage and ensure timely access to medications.

This role combines data entry, clinical review, and phone-based customer service while working independently in a structured, supportive team setting.