Remote Prior Authorization Pharmacy Tech – Medicare/Medicaid

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

Benefits offered by this job

Medical, dental & vision insurance

401(k) plan

Paid time off

Job summary

Actalent is seeking a Remote Pharmacy Technician Prior Authorization to support Medicare/Medicaid patients in a fully remote role. You will intake requests, perform technical reviews, and determine coverage using established criteria and SOPs.

The job combines data entry, managed care knowledge, and high-quality phone support to ensure timely decisions for patients’ medications. Training occurs during a defined schedule, with two primary remote shift options after training.

Qualifications

• This role requires active pharmacy technician certification (CPhT) and prior authorization experience.
• Experience with Medicare/Medicaid populations and managed care workflows is preferred.
• Strong data entry accuracy and ability to interpret insurance and medical documents.

Responsibilities

• Process intake and set up prior authorizations in internal systems.
• Conduct technical reviews and make coverage determinations per SOPs.
• Review cases for medication coverage and document outcomes.
• Read coverage criteria and medical documents to assess eligibility.
• Make approvals or denials per guidelines and policies.
• Enter data accurately for claims, authorizations, and patient info.
• Provide professional phone-based customer service to patients and providers.
• Maintain HIPAA compliance in a remote, distraction-limited setting.
• Collaborate on rotating holiday coverage and participate in training.

Skills

CPhT certification

Prior authorization experience

Managed care knowledge

Data entry accuracy

Phone-based customer service

HIPAA compliance

Tools

Remote work systems

Job description

Actalent is seeking a Remote Pharmacy Technician Prior Authorization to support Medicare/Medicaid patients in a fully remote role. You will intake requests, perform technical reviews, and determine coverage using established criteria and SOPs.

The job combines data entry, managed care knowledge, and high-quality phone support to ensure timely decisions for patients’ medications. Training occurs during a defined schedule, with two primary remote shift options after training.