Remote Pharmacy Tech: Medicare/Medicaid PA Specialist

Actalent; Orlando (FL); Remote; USD 28,000 - 32,000; Full time

Benefits offered by this job

Remote work

Contract-to-hire

Job summary

Actalent is seeking a Remote Pharmacy Technician to support Medicare and Medicaid patients by processing prior authorizations in a fully remote role. You will intake requests, perform technical reviews, and determine coverage based on established criteria, SOPs, and medical documentation.

The position combines detailed data entry, managed care knowledge, and customer service via phone to ensure timely decisions. The role is remote from Orlando, FL with benefits and a contract-to-hire path.

Qualifications

• Active pharmacy technician certification (such as CPhT).
• Hands-on experience as a pharmacy technician, preferably in a managed care or prior authorization setting.
• Experience with managed care and pharmacy operations, including Medicare/Medicaid populations.
• Demonstrated prior authorization experience, including intake, review, or claims-related activities.
• Strong data entry skills with high accuracy and attention to detail.
• Proficiency with computer systems and applications required for remote work and prior authorization processing.
• Customer service experience over the phone, including handling inbound and outbound calls.
• Ability to control conversations, manage difficult calls, and redirect discussions to maintain professionalism and clarity.
• Capability to work remotely and independently while meeting performance expectations.
• Solid understanding of pharmacy terminology and basic clinical concepts related to medication coverage and eligibility.

Responsibilities

• Process the intake of MedPharm prior authorization requests by accurately setting up prior authorizations in internal systems.
• Route completed intake cases to the review team and, once trained, assume responsibility for technical review of prior authorization cases.
• Review prior authorization cases to determine medication coverage, including approval, denial, or partial coverage decisions.
• Carefully read and interpret coverage criteria, SOPs, insurance documents, and medical documents to assess eligibility.
• Make clinical determinations on whether medications are approved or denied based on established guidelines and managed care policies.
• Perform accurate and timely data entry related to claims, prior authorizations, and patient information.
• Provide professional customer service over the phone, handling calls from patients and providers regarding prior authorization status and requirements.
• Control and guide conversations on calls, redirecting as needed to maintain focus and provide clear, concise information.
• Work independently in a remote environment, maintaining productivity and adherence to performance and quality standards.
• Ensure all work complies with HIPAA and other privacy and security requirements while working in a closed-door, distraction-limited setting.
• Collaborate with team members to support rotating holiday coverage and flexible scheduling needs.
• Participate in training and apply new processes, criteria, and system updates to daily work.

Skills

CPhT certification

Remote pharmacy tech

Medicare/Medicaid MA

Data entry accuracy

Phone-based service

Job description

Actalent is seeking a Remote Pharmacy Technician to support Medicare and Medicaid patients by processing prior authorizations in a fully remote role. You will intake requests, perform technical reviews, and determine coverage based on established criteria, SOPs, and medical documentation.

The position combines detailed data entry, managed care knowledge, and customer service via phone to ensure timely decisions. The role is remote from Orlando, FL with benefits and a contract-to-hire path.