Remote Prior Authorization Pharmacy Tech

Actalent; United States; 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)

Job summary

Actalent is hiring for a Remote Pharmacy Technician Prior Authorization to support Medicare and Medicaid patients from a fully remote environment. You will handle intake, conduct technical reviews, and make coverage determinations using established SOPs and insurance documentation.

The role emphasizes data entry, managed care pharmacy knowledge, and customer service by phone, with training and ongoing updates to criteria and systems. A strong remote-work setup is essential.

Qualifications

• Active pharmacy technician certification (e.g. CPhT).
• Experience as a pharmacy technician, preferably in managed care or prior authorization.
• Familiarity with Medicare/Medicaid in pharmacy operations.
• Prior authorization intake, review, or claims experience.
• Strong data entry accuracy and attention to detail.
• Proficiency with computer systems for remote work and PA processing.
• Phone-based customer service experience.
• Ability to control conversations and redirect discussions professionally.
• Ability to work remotely and independently while meeting performance goals.
• Solid understanding of pharmacy terminology and coverage basics.

Responsibilities

• Process intake of prior authorization requests and set up PA cases in internal systems.
• Route intake to review team and perform technical PA review when trained.
• Determine medication coverage decisions (approve/deny/partial).
• Read SOPs and insurance docs to assess eligibility for prior authorizations.
• Make clinical determinations based on guidelines and policies.
• Enter data accurately for claims, PA, and patient information.
• Provide professional phone-based customer service to patients and providers.
• Guide conversations on calls to maintain clarity and focus.
• Work remotely and independently while maintaining productivity and quality.
• Ensure HIPAA compliance in a distraction-limited home office.
• Support rotating holiday coverage and flexible scheduling.
• Participate in training and apply new processes and system updates.

Job description

Actalent is hiring for a Remote Pharmacy Technician Prior Authorization to support Medicare and Medicaid patients from a fully remote environment. You will handle intake, conduct technical reviews, and make coverage determinations using established SOPs and insurance documentation.

The role emphasizes data entry, managed care pharmacy knowledge, and customer service by phone, with training and ongoing updates to criteria and systems. A strong remote-work setup is essential.