Remote Pharmacy Technician
$20 - $22 per hourActalent
- Remote job
Job Title: Remote Pharmacy Technician Job Description This role focuses on supporting Medicare and Medicaid patients by processing and reviewing medication prior authorizations in a fully remote environment. You will begin with intake responsibilities and grow into a prior authorization review function, using your pharmacy technician experience and managed care knowledge to make coverage determinations. The position offers a strong culture, flexibility, and comprehensive benefits, while allowing you to work independently from a HIPAA-compliant home office. Responsibilities
- Handle the intake of prior authorization requests for medications, ensuring all required information is complete and accurately entered into internal systems.
- Set up prior authorization cases in the system and route them to the appropriate review technician in a timely and organized manner.
- Receive prior authorization cases from the intake team and perform detailed technical reviews to determine medication coverage.
- Read and interpret coverage criteria, standard operating procedures (SOPs), insurance documents, and medical documents to assess eligibility.
- Make clinical determinations regarding whether medications are approved, denied, or covered in any capacity, following established guidelines and criteria.
- Document decisions clearly and accurately within the system, ensuring all notes and justifications are complete and compliant.
- Provide professional customer service over the phone, handling inbound and outbound calls related to prior authorizations and coverage decisions.
- Control conversations effectively, redirect discussions when needed, and de-escalate challenging interactions while maintaining a calm and professional demeanor.
- Use strong data entry and computer skills to manage high volumes of cases with accuracy and attention to detail.
- Work independently in a remote setting, managing your time, workload, and priorities to meet productivity and quality standards.
- Collaborate with team members and leadership as needed to clarify criteria, resolve complex cases, and support continuous process improvement.
- Participate in training and ongoing education to stay current with policies, procedures, and managed care requirements.
- Pharmacy technician experience, preferably in a managed care or prior authorization environment.
- Pharmacy technician certification (such as CPhT) or eligibility and intent to obtain certification, as required by role or jurisdiction.
- Experience working with Medicare and Medicaid patients or payers.
- Hands-on experience with prior authorization processes for medications.
- Strong data entry skills with a high level of accuracy and attention to detail.
- Proficiency in computer use, including navigating multiple systems and applications simultaneously.
- Customer service experience over the phone, including handling a high volume of calls.
- Ability to control and guide conversations, redirect when necessary, and maintain professionalism during challenging interactions.
- Demonstrated ability to work remotely and independently while meeting performance expectations.
- Comfort with reading and interpreting insurance documents, coverage criteria, SOPs, and medical documents.
- I am scheduling phone interviews as early as today. All candidates will be considered immediately within 24 hours of applying directly to Fathima
- HOW TO APPLY DIRECTLY: Email your updated resume, brief intro about your interest, preferred method of communication for you (i.e., call, email, text) to View email address on click.appcast.io (View email address on click.appcast.io) or CALL- View phone number on click.appcast.io
$18 per hour
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