REMOTE Prior Authorization Technician

Actalent; United States; A distancia; USD 28.000 - 32.000; Jornada completa

Descripción de la vacante

Actalent is hiring a Remote MedPharma Pharmacy Technician to process and review Medicare and Medicaid prior authorizations. The role centers on intake, data accuracy, and clinical determinations in a fully remote, HIPAA-compliant environment.

You will handle intake setup, route cases to reviewers, and perform technical reviews to decide on approvals or denials. Strong data entry, insurance interpretation, and customer service are essential.

Formación

• Active Pharmacy Technician certification (CPhT) with experience as a Pharmacy Technician.
• Hands-on experience in managed care or similar environment with insurance, claims, and coverage determinations.
• Experience in pharmacy setting with familiarity in medication workflows and prior authorization processes.

Responsabilidades

• Process MedPharma prior authorizations for Medicare and Medicaid (primarily Medicare) according to procedures.
• Set up prior authorization cases in internal systems with accurate data entry.
• Route intake cases to review team and perform technical reviews when trained.
• Determine medication coverage decisions (approve, deny, or partial) based on criteria.
• Read insurance documents, SOPs, and medical documents to determine eligibility.
• Make clinical determinations on approvals/denials based on information and policies.
• Maintain HIPAA-compliant data accuracy for cases and patient information.
• Provide telephone-based customer service for prior authorizations and coverage decisions.

Conocimientos

CPhT Certification

Managed Care Experience

Prior Authorization

Data Entry

Customer Service

Remote Work Experience

HIPAA Compliance

Insurance Knowledge

Phone Support

Descripción del empleo

Job Title: Remote MedPharma Pharmacy Technician

Job Description

This remote Pharmacy Technician role focuses on processing and reviewing medication prior authorizations for Medicare and Medicaid patients, with a primary emphasis on Medicare. You will handle both intake and technical review functions, ensuring accurate data entry, thorough evaluation of coverage criteria, and clear clinical determinations on medication approvals and denials. The position offers a strong culture, flexibility, and benefits in a fully remote, HIPAA-compliant work environment.

Responsibilities

• Process MedPharma prior authorizations for Medicare and Medicaid patients, primarily Medicare, in accordance with established procedures and guidelines.
• Perform intake duties by setting up prior authorization cases in internal systems accurately and efficiently.
• Route completed intake cases to the review team and, once trained, handle technical review responsibilities.
• Conduct technical reviews of prior authorization cases to determine medication coverage, including approval, denial, or partial coverage decisions.
• Read and interpret coverage criteria, standard operating procedures (SOPs), insurance documents, and medical documents to determine eligibility.
• Make clinical determinations regarding whether medications are approved or denied based on available information and coverage policies.
• Ensure all data entry related to prior authorizations, claims, and patient information is accurate, complete, and compliant with regulations.
• Provide customer service over the phone, handling inbound and outbound calls related to prior authorizations and coverage decisions.
• Control and guide conversations with callers, redirecting as needed to gather required information and maintain a professional, efficient interaction.
• Use computer systems and software tools to manage cases, document decisions, and track workflow in a remote environment.
• Work independently in a remote setting while adhering to HIPAA requirements and maintaining confidentiality of patient information.
• Collaborate with team members on rotating holiday coverage and shared responsibilities to ensure consistent service levels.
• Participate in training and ongoing education to stay current on managed care, pharmacy practices, and prior authorization processes.

Essential Skills

• Active Pharmacy Technician certification (such as CPhT) with demonstrated experience as a Pharmacy Technician.
• Hands-on experience in managed care or a similar environment involving insurance, claims, and coverage determinations.
• Prior experience working in a pharmacy setting, with familiarity in medication workflows and prior authorization processes.
• Proficiency in data entry with strong attention to detail and accuracy in handling patient and insurance information.
• Customer service experience over the phone, including the ability to handle calls professionally and maintain composure.
• Skill in controlling and guiding conversations, including redirecting discussions to obtain necessary information and resolve issues.
• Strong computer skills and comfort working with multiple systems and digital documentation.
• Proven ability to work remotely and independently while managing workload and meeting performance expectations.
• Ability to read and interpret insurance documents, SOPs, and medical documentation to support clinical and coverage decisions.
• Commitment to maintaining HIPAA compliance and safeguarding sensitive patient information in a remote environment.

Additional Skills & Qualifications

• Experience with prior authorization processing in a managed care or pharmacy environment.
• Experience in claims-related work, including understanding of coverage rules and insurance terminology.
• Strong interpersonal and communication skills, both verbal and written, for interacting with patients, providers, and internal teams.
• Ability to adapt to varying schedules, including evening and weekend shifts, and participate in rotating holiday coverage.
• Comfort working in a structured, process-driven environment with clear SOPs and performance expectations.
• Interest in long-term, permanent opportunities that offer holidays, paid time off, flexibility, and benefits.
• Self-motivated mindset with the ability to stay focused and productive in a closed-door, distraction-free setting.

Work Environment

This position is 100% remote and requires working from a closed-door setting with limited distractions to maintain a HIPAA-compliant environment. You must have strong, reliable Wi‑Fi and the ability to work effectively from home using computer-based systems and digital documentation. Training takes place Monday through Friday from 10:00 a.m. to 6:30 p.m. EST. After training, you will work one of two schedules: a SundayThursday schedule (preferred hours of 12:008:30 p.m. or 12:309:00 p.m. EST, with Sunday hours of 8:00 a.m.4:30 p.m. EST) or a TuesdaySaturday schedule (TuesdayFriday preferred hours of 12:309:00 p.m. EST and Saturday hours of 8:00 a.m.4:30 p.m. EST). Holidays are covered on a rotating basis with other team members. Lunch breaks range from 30 minutes up to an hour, depending on scheduling and business needs. The culture emphasizes a high internal satisfaction score, flexibility, and benefits in a professional, supportive remote work setting.

Job Type & Location

This is a Contract to Hire position based out of Albuquerque, NM.

Pay and Benefits

The pay range for this position is $20.00 - $23.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your jobclassification and length of employment. Benefits are subject to change and may besubject to specific elections, plan, or program terms. If eligible, the benefitsavailable for this temporary role may include the following:Medical, dental & visionCritical Illness, Accident, and Hospital401(k) Retirement Plan Pre-tax and Roth post-tax contributions availableLife Insurance (Voluntary Life & AD&D for the employee and dependents)Short and long-term disabilityHealth Spending Account (HSA)Transportation benefitsEmployee Assistance ProgramTime Off/Leave (PTO, Vacation or Sick Leave)

Job Type & Location

This is a Contract to Hire position based out of Albuquerque, NM.

Application Deadline

This position is anticipated to close on Nov 6, 2026.

Workplace Type

This is a fully remote position.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.

The company is an equal opportunity employer and will consider all applications withoutregard to race, sex, age, color, religion, national origin, veteran status, disability,sexual orientation, gender identity, genetic information or any characteristic protectedby law.

If you would like to request a reasonable accommodation, such as the modification oradjustment of the job application process or interviewing process due to a disability,please email [e-mail] for other accommodation options.

San Francisco Fair Chance Ordinance:

Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in thecity and county of San Francisco, we will consider for employment qualified applicantswith arrest and conviction records.

Massachusetts Lie Detector:

It is unlawful in Massachusetts to require or administer a lie detector test as acondition of employment or continued employment. An employer who violates this lawshall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI):

We may use Artificial Intelligence (AI) to support parts of our hiring process,including sourcing, screening, and evaluating candidates. AI helps assess applicationsand qualifications, but final decisions are made by our hiring team. By applying, youacknowledge and agree that your application may be reviewed using AI tools.