Remote Pharmacy PA Tech — Medicare/Medicaid Specialist

Actalent; Tempe (AZ); Remote; USD 28,000 - 32,000; Full time

Benefits offered by this job

Dental & Vision insurance

401(k) plan

Paid time off

Job summary

Actalent is hiring a Remote Pharmacy Technician Prior Authorization Specialist to support patients by managing PA requests for Medicare and Medicaid prescriptions in a fully remote environment. You will perform intake and technical review, use pharmacy and managed care experience, and produce timely coverage determinations while adhering to SOPs and HIPAA guidelines.

The role combines data entry, clinical review, and phone-based customer service in a structured, supportive remote team setting,

Qualifications

• > 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.
• > Strong data entry skills with a high level of accuracy and attention to detail.
• > Demonstrated experience providing customer service over the phone, including handling calls related to healthcare or pharmacy services.
• > Ability to control and guide phone conversations, redirect discussions when necessary, and maintain a calm, professional demeanor.
• > Proficiency with computers and common software tools, including the ability to learn and navigate multiple systems simultaneously.
• > Ability to work independently and effectively in a fully remote environment with minimal direct supervision.
• > Strong reading comprehension skills to interpret criteria, SOPs, insurance policies, and medical documentation.

Responsibilities

• 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, standard operating procedures (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 evening and weekend shifts, and manage time effectively during training and regular operations.
• Utilize computer systems and software tools efficiently to manage workflow, review documentation, and communicate with colleagues.

Skills

Pharmacy technician certification (CPh

Managed care experience

Prior authorization workflows

Data entry accuracy

Phone-based customer service

Remote work independence

Systems navigation

Reading medical documentation

Tools

MedPharm

Job description

Actalent is hiring a Remote Pharmacy Technician Prior Authorization Specialist to support patients by managing PA requests for Medicare and Medicaid prescriptions in a fully remote environment. You will perform intake and technical review, use pharmacy and managed care experience, and produce timely coverage determinations while adhering to SOPs and HIPAA guidelines.

The role combines data entry, clinical review, and phone-based customer service in a structured, supportive remote team setting,