Pharmacy Technician (Prior Authorization

Job Description

Job Description

Pharmacy Technician

This role focuses on managing end-to-end prior authorization and insurance verification processes for specialty medications, ensuring patients gain timely access to therapy while receiving accurate, high-quality support. You will work in a hybrid office and remote environment, handling detailed pharmacy and insurance tasks, communicating with patients and healthcare providers, and supporting a rapidly growing specialty pharmacy operation dedicated to improving outcomes for individuals with rare and complex diseases.

Responsibilities

• Recognize and clearly communicate different insurance types and explain when each type should be utilized for patient coverage.
• Communicate with patients to gather complete and accurate insurance information needed for prior authorizations and claims processing.
• Enter all communication, documentation, and case updates into the Biologics MIS system in a timely and accurate manner.
• Appropriately process pharmacy claims in the Biologics MIS and interpret pharmacy claim responses to determine next steps.
• Triage prescriptions to preferred pharmacies or HUB providers when the specialty pharmacy is unable to serve the patient, ensuring continuity of care.
• Manage inbound calls from patients, clients, physicians, and payors regarding patient updates, prior authorization status, and services provided.
• Conduct significant outbound calling to patients, clinics, and insurance providers to initiate, follow up on, and complete prior authorizations.
• Review clinic notes and large medical records, often 90 or more pages, to identify required documentation that meets payer requirements.
• Work closely with CoverMyMeds and insurance providers to submit, track, and resolve prior authorization requests.
• Identify and report adverse events and product complaints to clinicians according to established procedures.
• Manage and respond to internal written communications and requests received via chat or email in a professional and timely manner.
• Assist with projects such as yearly reverification and other operational initiatives related to patient access and insurance coverage.
• Navigate patient cases and proactively resolve barriers to treatment, exploring all available options before accepting a denial.
• Meet productivity expectations by managing approximately 16–20 patient cases per day while maintaining high accuracy and attention to detail.
• Perform other related duties as assigned by the supervisor to support the overall operations of the specialty pharmacy.

Essential Skills

• Prior authorization experience in a hospital, specialty pharmacy, physician office, or healthcare setting is highly preferred.
• Strong pharmacy experience in pharmacy services and workflows.
• Hands-on experience with insurance verification and understanding of payer requirements.
• Knowledge of medical billing and coding principles relevant to pharmacy claims and prior authorizations.
• Ability to review and interpret clinic notes and extensive medical records to extract necessary documentation.
• Comfort working with complex, detail-oriented, and time-intensive processes related to prior authorizations.
• Proficiency in managing both inbound and outbound calls with patients, clinics, and insurance providers.
• Ability to recognize and understand pharmacy claim responses and determine appropriate follow-up actions.
• Strong documentation skills, including accurate data entry into systems such as Biologics MIS.
• Persistence and resourcefulness, with a willingness to explore all options before accepting a negative outcome.
• Ability to navigate patient cases and resolve barriers to treatment with a patient-centered approach.
• Capacity to work independently in a hybrid environment while meeting productivity expectations of 16–20 patients per day.

Additional Skills & Qualifications

• Prior authorizations experience in a hospital, specialty pharmacy, or healthcare setting is strongly preferred.
• Medical Assistant experience is considered a strong plus.
• Registered Pharmacy Technician status is nice to have.
• Certified Pharmacy Technician (CPhT) credential is a plus.
• Experience working with CoverMyMeds or similar prior authorization platforms.
• experience in medical billing and coding and pharmacy services.
• Comfort working with large volumes of medical documentation and multitasking in a fast-paced environment.
• Strong communication skills for interacting with patients, clinicians, payors, and internal teams.
• Ability to collaborate within a multidisciplinary team focused on rare and complex diseases.
• Adaptability to shifting workloads, including increased volume due to new drug launches.

Work Environment

This position operates in a hybrid work environment that combines remote work with in-office days. You must be able to work independently from home while attending mandatory in-office days on Tuesdays. The role is based in an office setting with no direct face-to-face patient contact, as all patient interaction occurs via phone and electronic communication. The specialty pharmacy is open Monday through Friday from 8:00 AM to 8:00 PM EST and is closed on weekends and major holidays. Flexible shift options typically include 8:00 AM–5:00 PM, 9:00 AM–6:00 PM, 10:00 AM–7:00 PM, and 11:00 AM–8:00 PM, with most hires expected to work earlier shifts. You will work within a large, rapidly growing specialty pharmacy environment, supported by a multidisciplinary team dedicated to simplifying access to medication and delivering personalized care for patients with rare diseases. The culture emphasizes employee engagement, collaboration, and a strong commitment to patient outcomes, with standard professional office attire expected during in-office days.

This is a Contract to Hire position based out of Cary, NC.

The pay range for this position is $22.50 - $22.50/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 hybrid position in Cary,NC.

This position is anticipated to close on Sep 30, 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 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 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 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.