Remote Pharmacy Prior Authorization Technician

Actalent; Houston (TX); Remote; USD 28,000 - 32,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

Paid time off

Remote work

Job summary

Actalent is seeking a Remote MedPharma Pharmacy Technician to process and review prior authorizations for Medicare and Medicaid patients, with emphasis on Medicare. You will perform intake setup, route cases for review, and conduct technical determinations on coverage, ensuring accurate data entry and HIPAA compliance in a fully remote environment.

You will work from home with HIPAA-security, participate in training, and support rotating schedules while delivering high-quality service across

Qualifications

• CPhT certification and pharmacy technician experience.
• Experience in managed care, insurance, claims, and coverage determinations.
• Experience with prior authorization processing in pharmacy settings.
• Strong data-entry accuracy and HIPAA compliance.

Responsibilities

• Process MedPharma prior authorizations for Medicare and Medicaid patients.
• Perform intake duties by setting up prior authorization cases in internal systems.
• Route completed intake cases to the review team and handle technical review when trained.
• Conduct technical reviews to determine medication coverage and approval/denial decisions.
• Read and interpret coverage criteria, SOPs, insurance documents, and medical docs.
• Make clinical determinations on approvals or denials based on information and policies.
• Ensure accurate data entry related to prior authorizations, claims, and patient data.
• Provide customer service over the phone for intake and coverage decisions.
• Guide conversations to gather required information and maintain professional interactions.
• Use computer systems to manage cases, document decisions, and track workflow remotely.
• Work independently in a remote setting while maintaining HIPAA confidentiality.
• Collaborate on rotating holiday coverage and shared responsibilities.
• Participate in training and ongoing education on managed care and prior authorization.

Skills

CPhT certification

Pharmacy technician

Managed care insurance

Data entry

Customer service

Remote work

HIPAA compliance

Education

Active Pharmacy Technician certification (CPhT)

Tools

Pharmacy software

Job description

Actalent is seeking a Remote MedPharma Pharmacy Technician to process and review prior authorizations for Medicare and Medicaid patients, with emphasis on Medicare. You will perform intake setup, route cases for review, and conduct technical determinations on coverage, ensuring accurate data entry and HIPAA compliance in a fully remote environment.

You will work from home with HIPAA-security, participate in training, and support rotating schedules while delivering high-quality service across