Remote Pharmacy Technician

Remote Pharmacy Technician Prior Authorization SpecialistThis role offers an opportunity for a certified Pharmacy Technician to support patients by managing prior authorizations for Medicare and Medicaid prescriptions in a fully remote environment. You will handle both intake and technical review functions, using your pharmacy and managed care experience to determine coverage and ensure patients receive timely access to their medications. This position combines detailed data entry, clinical review, and phone-based customer service while working independently in a structured, supportive team setting.ResponsibilitiesProcess 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.Essential SkillsActive Pharmacy Technician certification (such as CPhT) with eligibility to perform pharmacy technician duties.Pharmacy technician experience, preferably in a managed care or similar environment.Hands-on experience with managed care or pharmacy benefit processes, including prior authorization workflows.Strong data entry skills with a high level of accuracy and attention to detail.Demonstrated experience providing customer service over the phone, including handling calls related to healthcare or pharmacy services.Ability to control and guide phone conversations, redirect discussions when necessary, and maintain a calm, professional demeanor.Proficiency with computers and common software tools, including the ability to learn and navigate multiple systems simultaneously.Ability to work independently and effectively in a fully remote environment with minimal direct supervision.Strong reading comprehension skills to interpret criteria, SOPs, insurance policies, and medical documentation.Capability to make sound clinical coverage determinations within the scope of a pharmacy technician role.Reliable high-speed internet connection and the technical ability to support remote work requirements.Additional Skills & QualificationsPrevious experience working with Medicare and Medicaid patient populations.Background 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.Interest in long-term opportunities that may include conversion to a permanent role with access to holiday benefits, paid time off, flexibility, and other benefits, subject to employer policies.Work EnvironmentThis is a 100% remote position that requires working from a closed-door setting with limited distractions to maintain confidentiality and productivity. The work environment must be fully HIPAA compliant, and you must have strong, reliable Wi-Fi to support continuous system access, calls, and documentation. 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. The role relies heavily on computer-based systems, electronic documentation, and phone communication, and you will work as part of a culturally strong, supportive team that values flexibility, benefits, and a positive internal environment.Job Type & LocationThis is a Contract to Hire position based out of Atlanta, GA.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)