Remote Pharmacy Technician: Formulary & Prior Authorization

Actalent; City of Rochester (NY); Remote; USD 28,000 - 32,000; Full time

Job summary

Actalent is seeking a Pharmacy Technician to support formulary management, audits, and coordination of prior authorization processes for SHP and Medicare programs. The role involves reviewing drug requests, resolving issues with Clinical Pharmacists, and ensuring compliance through audits.

The position offers a fully remote work arrangement for a Contract to Hire opportunity with competitive hourly pay and opportunities for training and development within a dynamic health services team.

Qualifications

• High School diploma or GED is required.
• At least 1 year of Pharmacy Technician experience.
• Customer service or retail experience.
• Valid Pharmacy Technician License preferred.

Responsibilities

• Review and process formulary change requests and maintain formulary status grids.
• Perform audits and quality checks on formulary status for accuracy and compliance.
• Assist Clinical Pharmacists with formulary database maintenance and updates.
• Perform assignments related to pharmacy audit and recovery, including reviewing paid claims for discrepancies.
• Handle member inquiries and educate them on pharmacy benefits and prior authorization options.
• Review and document prior authorization requests and resolve related issues.
• Process PDE files, perform audits, and assist with pharmacy claims corrections.
• Liaise with internal and external departments for SHP pharmacy operational issue resolution.
• Prepare and review operational reports and audits for SHP formulary management.
• Assist in the implementation of regulatory changes and maintain consistent processes.
• Identify validity of appeals and research using formularies to verify if additional information is needed.
• Track and triage coverage determination and prior authorization requests for Medicare Part D and Part B.

Skills

Customer Service

Retail Experience

Pharmacy Technician Experience

Education

High School diploma or GED

Pharmacy Technician License

Job description

Actalent is seeking a Pharmacy Technician to support formulary management, audits, and coordination of prior authorization processes for SHP and Medicare programs. The role involves reviewing drug requests, resolving issues with Clinical Pharmacists, and ensuring compliance through audits.

The position offers a fully remote work arrangement for a Contract to Hire opportunity with competitive hourly pay and opportunities for training and development within a dynamic health services team.