Pharmacy Technician

Pharmacy Technician Prior Authorization & Specialty Pharmacy Support Position Overview We are seeking a highly detail-oriented Pharmacy Technician to support end-to-end prior authorization and insurance navigation activities for patients receiving specialty medications. In this role, you will manage patient cases throughout the entire access journey, from initial intake and benefits investigation through claim resolution and therapy approval. This position plays a critical role in ensuring patients receive timely access to life-changing therapies by working directly with patients, provider offices, insurance carriers, and internal stakeholders. The ideal candidate combines strong pharmacy and insurance knowledge with exceptional communication skills, persistence, and a patient-first mindset. Success in this role requires the ability to effectively manage multiple cases, interpret complex insurance requirements, and thrive in a fast-paced, highly regulated specialty pharmacy environment. Key Responsibilities Prior Authorization & Insurance Support * Assess and identify applicable insurance coverage, including understanding various insurance types and determining the appropriate payer sequence for patient claims. * Collect, verify, and update patient insurance information required for prior authorization submissions and claims processing. * Review payer-specific prior authorization requirements and ensure submissions are prepared accurately and completely. * Submit, monitor, and resolve prior authorization requests through insurance carriers and platforms such as CoverMyMeds. * Work proactively to identify solutions for access barriers, exploring all available options before accepting denials or coverage limitations. * Support a fully managed, end-to-end prior authorization process, taking ownership of cases from initiation through final resolution. Claims Processing & Patient Access * Process pharmacy claims accurately within the Biologics Management Information System (MIS). * Interpret pharmacy claim responses and determine appropriate next steps to facilitate patient access to therapy. * Coordinate prescription transfers to preferred specialty pharmacies or HUB providers when services cannot be fulfilled internally, ensuring continuity of patient care. * Assist with annual insurance reverification activities and other operational initiatives designed to support patient access. Patient, Provider & Payer Communication * Serve as a primary point of contact for patients, healthcare providers, payers, and clients regarding prior authorization status, patient updates, and available services. * Manage a high volume of inbound calls and conduct extensive outbound outreach to patients, clinics, and insurance companies. * Obtain required documentation, clarify insurance requirements, and facilitate timely progression of authorization requests. * Respond promptly and professionally to internal communications received through email, chat, and other channels. Documentation & Compliance * Maintain accurate and thorough documentation of all communications, case activity, and updates within Biologics MIS and other internal systems. * Review extensive clinical documentation and medical records, often exceeding 90 pages, to identify and extract the information required for payer approval. * Identify and report adverse events and product complaints in accordance with established compliance and reporting procedures. * Ensure all activities are completed in alignment with organizational standards, regulatory requirements, and quality expectations. Performance & Productivity * Manage a daily caseload of approximately 16 to 20 patient cases while maintaining a high level of accuracy and quality. * Demonstrate strong organizational skills and attention to detail within a deadline-driven environment. * Support additional departmental projects and responsibilities as assigned by leadership. Required Qualifications * Prior experience supporting prior authorization processes within a hospital, specialty pharmacy, physician practice, or healthcare environment. * Experience with pharmacy operations, insurance verification, pharmacy claims processing, or related healthcare reimbursement functions. * Strong understanding of insurance plans, payer structures, and coverage determination processes. * Ability to interpret pharmacy claim responses and identify appropriate follow-up actions. * Knowledge of medical billing, coding, or healthcare insurance workflows. * Experience reviewing medical records and clinical documentation to identify payer-required information for authorization approvals. * Comfortable handling significant inbound and outbound phone communication with patients, providers, and insurance representatives. * Exceptional attention to detail with strong documentation and data-entry skills. * Proven ability to manage multiple priorities and maintain productivity in a fast-paced environment. * Strong written and verbal communication skills. * Experience using case management systems and online prior authorization platforms, including CoverMyMeds or similar tools. * Ability to work independently while maintaining productivity and quality standards in a hybrid work environment. * Demonstrated persistence, critical thinking, and problem-solving skills when navigating insurance and access-related challenges. Preferred Qualifications * Previous prior authorization experience within a specialty pharmacy, health system, or physician office setting. * Experience working as a Medical Assistant. * Pharmacy registration or licensure, where applicable. * Certified Pharmacy Technician (CPhT) certification. * Experience supporting specialty medications, oncology therapies, biologics, or rare disease treatments. * Ability to adapt to fluctuations in workload, including periods of increased volume related to new product launches or business growth. * Track record of success in collaborative, patient-focused healthcare environments. Work Environment This opportunity supports a rapidly growing specialty pharmacy organization dedicated to simplifying medication access and delivering personalized support to patients, including those managing complex and rare disease conditions. The team operates in a hybrid work model. Employees are required to work onsite each Tuesday, with the remainder of the workweek typically performed remotely based on business needs. Operating hours are Monday through Friday, 8:00 AM to 8:00 PM Eastern Time, with no weekend or major holiday coverage requirements. Available shifts generally include: * 9:00 AM to 6:00 PM ET * 10:00 AM to 7:00 PM ET * 11:00 AM to 8:00 PM ET Most new hires are scheduled on earlier shifts. This is a phone-intensive, office-based role with no direct face-to-face patient interaction. Team members work closely with patients, providers, payers, and internal stakeholders while utilizing systems such as Biologics MIS and CoverMyMeds to facilitate timely access to specialty therapies. The organization fosters a collaborative, engagement-focused culture centered on operational excellence and exceptional patient support. Job Type & Location This is a Contract to Hire position based out of Cary, NC. Pay and Benefits The pay range for this position is $22.50 - $22.50/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a hybrid position in Cary,NC. Application Deadline This position is anticipated to close on Aug 21, 2026. 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 without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email View email address on click.appcast.io for other accommodation options. San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records. Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall 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. 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