Remote Prior Authorization Specialist (Medicare Focus)

Actalent; Albuquerque (NM); Teletrabalho; USD 28 000 - 32 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical, dental & vision

401(k) Retirement Plan

Paid time off

Disability benefits

Resumo da oferta

Actalent is seeking a fully remote MedPharma Pharmacy Technician to process and review prior authorizations for Medicare and Medicaid patients, with an emphasis on Medicare. This role handles intake duties, data entry, and, after training, technical reviews to determine coverage decisions.

Working from home, you will collaborate with the review team, adhere to HIPAA regulations, and support a flexible schedule while maintaining accuracy and customer service excellence.

Qualificações

• Active Pharmacy Technician certification (CPhT) required.
• Experience in managed care, insurance, claims, and coverage determinations preferred.
• Prior pharmacy setting experience with prior authorization processes.
• Strong data entry accuracy and attention to patient/insurance information.
• Customer service experience over the phone and professional communication.
• Ability to work remotely and maintain HIPAA compliance.
• Comfort using multiple systems and digital documentation.

Responsabilidades

• Process MedPharma prior authorizations for Medicare/Medicaid, mainly Medicare.
• Set up intake cases in internal systems accurately.
• Route cases to review team and perform technical reviews when trained.
• Determine coverage decisions (approve/deny/partial) based on criteria.
• Read insurance documents and SOPs to assess eligibility.
• Maintain accurate data entry for authorizations, claims, and patient info.

Conhecimentos

Active CPhT certification

Managed care experience

Pharmacy workflow knowledge

Data entry accuracy

Phone-based customer service

Remote work capable

HIPAA compliance

Descrição da oferta de emprego

Actalent is seeking a fully remote MedPharma Pharmacy Technician to process and review prior authorizations for Medicare and Medicaid patients, with an emphasis on Medicare. This role handles intake duties, data entry, and, after training, technical reviews to determine coverage decisions.

Working from home, you will collaborate with the review team, adhere to HIPAA regulations, and support a flexible schedule while maintaining accuracy and customer service excellence.