Remote Prior Authorization Specialist - Medicare Pharmacy

Actalent; Tucson (AZ); Remote; USD 28,000 - 32,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Life insurance

HSA

Paid time off

PTO/Leave benefits

Transportation benefits

Employee Assistance Program

Job summary

Actalent in Tucson, AZ seeks a Remote MedPharma Pharmacy Technician to process and review Medicare/Medicaid prior authorizations. You will handle intake, perform technical reviews, and determine coverage decisions while maintaining HIPAA compliance.

The role emphasizes remote work from a closed setting, strong data-entry discipline, and collaboration with a review team. Training and rotating schedules are provided.

Qualifications

• Active Pharmacy Technician certification and experience as a technician.
• Hands-on experience with managed care, claims, and coverage determinations.
• Pharmacy setting background with prior authorization workflows.
• Accurate data entry and handling of patient and insurer information.
• Phone-based customer service experience and professional communication.
• Experience working remotely with HIPAA-compliant practices.

Responsibilities

• Process MedPharma prior authorizations for Medicare and Medicaid patients.
• Set up and manage intake cases in internal systems.
• Route cases to the review team and perform technical reviews.
• Determine coverage decisions by reading SOPs and insurance docs.
• Make clinical determinations on medication approvals or denials.
• Maintain accurate, compliant data entry for authorizations and claims.
• Provide customer service on calls and manage scheduling with callers.
• Use remote systems to document decisions and track workflow.

Skills

Pharmacy tech cert

Managed care experience

Pharmacy setting experience

Data entry accuracy

Phone-based customer service

Remote work experience

Insurance documents reading

HIPAA compliance

Tools

Internal systems

Job description

Actalent in Tucson, AZ seeks a Remote MedPharma Pharmacy Technician to process and review Medicare/Medicaid prior authorizations. You will handle intake, perform technical reviews, and determine coverage decisions while maintaining HIPAA compliance.

The role emphasizes remote work from a closed setting, strong data-entry discipline, and collaboration with a review team. Training and rotating schedules are provided.