Remote Prior Authorization Pharmacy Technician – Payer-Side

Medix Staffing Solutions, Inc.; United States; Remote; USD 28,000 - 39,000; Full time

Job summary

Medix Staffing Solutions, Inc. is seeking a Pharmacy Technician for a remote payer-side prior authorization review role. You will adjudicate PA requests by applying formulary criteria and clinical guidelines to determine coverage.

The position requires an active, unrestricted Pharmacy Technician License and the ability to navigate CMS, Medicaid, and commercial turnaround standards while maintaining high accuracy in a fast-paced, high-volume environment.

Qualifications

• Must have direct payer-side prior authorization review/adjudication experience.
• Ability to read, interpret, and apply clinical criteria and formulary guidelines.
• Demonstrated ability to read and apply utilization management rules.
• High-volume data entry accuracy with strong communication for providers.
• Ability to work under strict deadlines in a compliance-driven environment.

Responsibilities

• Payer-Side Coverage Review & Adjudication: apply criteria and rules to determine eligibility.
• Provider & Member Coordination: liaise with prescribers, pharmacies, and members to gather notes and communicate outcomes.
• Audit-Ready Documentation: maintain thorough records in internal claims/case management systems.
• Support Appeals & Reconsiderations: assist with reconsiderations and appeals workflows.
• Strict Regulatory Compliance: adhere to CMS, state Medicaid, and turnaround time standards.

Skills

PA adjudication

High-volume data entry

Communication skills

Regulatory compliance

Education

Active Pharmacy Technician license

Job description

Medix Staffing Solutions, Inc. is seeking a Pharmacy Technician for a remote payer-side prior authorization review role. You will adjudicate PA requests by applying formulary criteria and clinical guidelines to determine coverage.

The position requires an active, unrestricted Pharmacy Technician License and the ability to navigate CMS, Medicaid, and commercial turnaround standards while maintaining high accuracy in a fast-paced, high-volume environment.