Remote Pharmacy Technician

Job Description

Job Description

Job Title: Remote Pharmacy Technician Prior Authorization Specialist

This is a 100% remote position that requires working from a closed-door setting with limited distractions to maintain confidentiality and productivity.

Responsibilities

• Process prior authorization (PA) requests for Medicare and Medicaid patients, with a primary focus on Medicare cases.
• Perform intake of MedPharm prior authorization requests by gathering required information and accurately setting up PA cases in internal systems.
• Route completed intake cases to the review team and, once trained, perform both intake and technical review functions as needed.
• Conduct technical review of PA cases by carefully reading and interpreting criteria, standard operating procedures (SOPs), insurance documents, and medical records.
• Make clinical determinations on medication coverage, including whether a prescription should be approved, denied, or covered under specific conditions.
• Document all decisions clearly and accurately in the appropriate systems, ensuring compliance with internal policies and regulatory requirements.
• Use strong data entry skills to maintain accurate, up-to-date records for each prior authorization case.
• Provide customer service over the phone, handling inbound and outbound calls related to prior authorizations and coverage determinations.
• Control and guide conversations with callers, redirecting as needed to obtain required information and maintain a professional, efficient interaction.
• Collaborate with team members in a remote environment to ensure timely processing of cases and equitable distribution of rotating holiday coverage.
• Follow all HIPAA and confidentiality requirements when handling patient information and working in a remote setting.
• Participate in training and ongoing development to expand from intake responsibilities into full technical review capabilities.
• Adhere to established schedules, including evening and weekend shifts, and manage time effectively during training and regular operations.
• Utilize computer systems and software tools efficiently to manage workflow, review documentation, and communicate with colleagues.

Skills & Qualifications

• Previous experience working with Medicare and Medicaid patient populations.
• Experience in a pharmacy setting that involved claims processing, insurance coordination, or prior authorizations.
• Familiarity with MedPharm or similar prior authorization platforms and workflows.
• Experience in managed care pharmacy, including understanding of coverage criteria and benefit structures.
• Strong organizational skills and the ability to manage multiple cases and priorities in a fast-paced environment.
• Effective written and verbal communication skills for documenting decisions and interacting with patients, providers, and team members.
• Comfort working flexible schedules, including evenings, weekends, and rotating holiday coverage.

Work Environment

• Training is conducted Monday through Friday from 10:00 a.m. to 6:30 p.m. Eastern Time.
• After training, schedules follow either a SundayThursday or TuesdaySaturday pattern.
• For a SundayThursday schedule, preferred hours are 12:008:30 p.m. or 12:309:00 p.m. Eastern Time, with Sunday shifts typically 8:00 a.m. to 4:30 p.m. Eastern Time.
• For a TuesdaySaturday schedule, preferred hours are 12:309:00 p.m. Eastern Time on Tuesday through Friday, with Saturday shifts typically 8:00 a.m. to 4:30 p.m. Eastern Time.
• Holiday coverage rotates among team members.
• Lunch breaks range from 30 minutes to approximately one hour, coordinated with operational needs.

This is a Contract to Hire position based out of San Antonio, TX.

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 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)

This is a Contract to Hire position based out of San Antonio, TX.

This position is anticipated to close on Nov 10, 2026.

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 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 ziprecruiter.com 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. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.