REMOTE Prior Authorization Pharmacy Technician

Remote Pharmacy Technician Prior AuthorizationThis role focuses on supporting Medicare and Medicaid patients by processing and reviewing medication prior authorizations in a fully remote environment. You will start with intake of prior authorization requests and be trained to perform technical reviews, making clinical coverage determinations based on established criteria, SOPs, and insurance and medical documentation. The position combines detailed data entry, managed care pharmacy knowledge, and customer service over the phone to ensure patients receive timely and accurate decisions regarding their medications.ResponsibilitiesProcess the intake of MedPharm prior authorization requests by accurately setting up prior authorizations in internal systems.Route completed intake cases to the review team and, once trained, assume responsibility for technical review of prior authorization cases.Review prior authorization cases to determine medication coverage, including approval, denial, or partial coverage decisions.Carefully read and interpret coverage criteria, standard operating procedures (SOPs), insurance documents, and medical documents to assess eligibility.Make clinical determinations on whether medications are approved or denied based on established guidelines and managed care policies.Perform accurate and timely data entry related to claims, prior authorizations, and patient information.Provide professional customer service over the phone, handling calls from patients and providers regarding prior authorization status and requirements.Control and guide conversations on calls, redirecting as needed to maintain focus and provide clear, concise information.Work independently in a remote environment, maintaining productivity and adherence to performance and quality standards.Ensure all work complies with HIPAA and other privacy and security requirements while working in a closed-door, distraction-limited setting.Collaborate with team members to support rotating holiday coverage and flexible scheduling needs.Participate in training and apply new processes, criteria, and system updates to daily work.Essential SkillsActive pharmacy technician certification (such as CPhT).Hands-on experience as a pharmacy technician, preferably in a managed care or prior authorization setting.Experience with managed care and pharmacy operations, including working with Medicare and Medicaid populations.Demonstrated prior authorization experience, including intake, review, or claims-related activities.Strong data entry skills with high accuracy and attention to detail.Proficiency with computer systems and applications required for remote work and prior authorization processing.Customer service experience over the phone, including handling inbound and outbound calls.Ability to control conversations, manage difficult calls, and redirect discussions to maintain professionalism and clarity.Capability to work remotely and independently while meeting performance expectations.Solid understanding of pharmacy terminology and basic clinical concepts related to medication coverage and eligibility.Additional Skills & QualificationsExperience in managed care pharmacy environments, including health plans or pharmacy benefit management.Familiarity with claims processing and insurance coverage criteria.Comfort reading and interpreting SOPs, insurance policies, and medical documentation.Strong organizational skills and ability to manage multiple prior authorization cases simultaneously.Excellent written and verbal communication skills for documentation and customer interactions.Ability to adapt to flexible schedules, including evenings, weekends, and rotating holiday coverage.Interest in working in a high-culture, supportive environment that values flexibility, paid time off, holidays, and benefits.Work EnvironmentThis is a 100% remote position that requires working from a closed-door setting with limited distractions to maintain HIPAA compliance and protect patient privacy. You must have strong, reliable Wi-Fi and a suitable home office environment to support uninterrupted computer-based work and phone calls. 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 primary schedule options: a SundayThursday schedule (with Sunday 8:00 a.m.4:30 p.m. EST and preferred weekday hours of 12:008:30 p.m. or 12:309:00 p.m. EST) or a TuesdaySaturday schedule (with Saturday 8:00 a.m.4:30 p.m. EST and preferred weekday hours of 12:309:00 p.m. EST). Holiday coverage rotates among team members, and lunch breaks range from 30 minutes to approximately one hour. The culture emphasizes a strong internal engagement score.Job Type & LocationThis is a Contract to Hire position based out of Chicago, IL.Pay and BenefitsThe 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)About ActalentActalent 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. 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.