Remote Prior Authorization Pharmacy Technician

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

Disability coverage

Health Spending Account (HSA)

Paid time off (PTO)

Job summary

Actalent is seeking a Remote Pharmacy Technician to support Medicare and Medicaid patients by processing and reviewing medication prior authorizations in a fully remote environment. You will intake requests, perform technical reviews, and make coverage determinations using SOPs and insurance documentation.

Strong data entry and customer service skills are essential. Key duties include handling intake, routing cases, validating coverage decisions, and maintaining HIPAA-compliant workflows in a

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 working with Medicare and 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

Managed care experience

Prior authorization

Data entry accuracy

Remote work tech skills

Phone-based customer service

Communication control on calls

Independent remote work

Pharmacy terminology knowledge

Job description

Actalent is seeking a Remote Pharmacy Technician to support Medicare and Medicaid patients by processing and reviewing medication prior authorizations in a fully remote environment. You will intake requests, perform technical reviews, and make coverage determinations using SOPs and insurance documentation.

Strong data entry and customer service skills are essential. Key duties include handling intake, routing cases, validating coverage decisions, and maintaining HIPAA-compliant workflows in a