Remote Pharmacy Technician

Remote Pharmacy Technician

This role involves performing technically detailed pharmacy and benefit work that impacts pharmacy and health plan operations, programs, and information systems within the Pharmacy Services Department. The position integrates technical pharmacy aspects with medical review, case management, mental health/chemical dependency, and quality management. As a Remote Pharmacy Technician, you will communicate directly with customer service teams, network pharmacies, regulatory entities, pharmacists, nurses, physicians, and other healthcare providers to manage claims, medication management programs, and initiatives.

Responsibilities

• Provide excellent member care by resolving issues and creating a smooth experience during first-contact interactions.
• Maintain strong customer service with external partners, including pharmacies, prescribers, and caregivers, to build lasting relationships.
• Serve as a liaison and problem-solver across providers, members, payors, and internal departments.
• Identify and respond to medical preauthorization requests requiring urgent clinical review.
• Manage multiple priorities and deadlines independently while collaborating effectively with the team.
• Administer pharmacy benefits, pharmacy network contracts, and employer group contracts in alignment with organizational goals and regulatory requirements.
• Apply knowledge of medical drug benefits and channel management, including contracted networks and policies.
• Interpret and respond to member behavior and self-reported information across all age populations to support individualized care needs.
• Independently coordinate and process pharmacy prior authorizations using benefit plans, utilization policies, approval criteria, prescriber information, and patient-specific factors.
• Maintain member eligibility processes and databases; oversee daily claims transactions and escalate irregularities.
• Answer, triage, and document incoming calls and requests, resolving or routing them appropriately based on urgency and protocols.
• Perform intake and data entry for authorizations, referrals, demographics, discharge data, medication therapy management, and utilization management.
• Use judgment to escalate cases requiring pharmacist or physician intervention according to established guidelines.
• Assign accurate coding for services, diagnoses, procedures, and identifiers using ICD-10 and CPT-4 systems.
• Provide coding support and technical assistance to clinical reviewers.
• Conduct system searches to gather documentation for case review and assist with loss report maintenance.
• Communicate prior authorization outcomes and medication-related issues to prescribers, including documentation of communication.
• Act as a departmental resource for members, providers, and internal teams to address workflow, system, and process questions.
• Communicate with members, pharmacies, and providers to obtain necessary information, approvals, and signatures; draft written communications as needed.
• Audit claims, documentation, and correspondence for accuracy, completeness, and quality.
• Support customer service, marketing, provider relations, and other stakeholders with information and communication needs.
• Train providers, office staff, members, payors, and internal teams on pharmacy processes and system usage.
• Serve as a subject matter resource on pharmacy operations and health plan processes within scope.
• Maintain confidentiality and security of medical records, ensuring compliance with record retention and purge protocols.
• Track, analyze, and report work activity data; develop reports to measure quality and effectiveness and recommend improvements.
• Research and resolve pending claims, authorizations, and incomplete records.
• Authorize payment of pharmacy claims and direct member reimbursements per policy.
• Collect, organize, review, and verify records from prescribers and pharmacies for regulatory compliance and audits.
• Maintain working knowledge of health plan pharmacy operations, policies, procedures, and healthcare regulations.
• Identify and communicate training needs or system improvement opportunities to leadership.
• Develop and update written procedures for workflow processes.
• Apply knowledge of medical terminology, anatomy, physiology, pharmaceuticals, pharmacy service models, billing, and pricing.
• Demonstrate strong written, verbal, interpersonal, and phone communication skills with providers, staff, and members.
• Organize and catalog pharmaceutical information related to conditions, procedures, and billing.
• Independently prioritize, organize, and manage multiple projects and workloads in a fast-paced environment.
• Apply analytical, problem-solving, research, and database management skills with strong attention to detail.
• Perform pharmaceutical calculations accurately and efficiently.
• Obtain and evaluate medical and drug information required to process requests.
• Follow established medical policies, protocols, and procedures; escalate gaps in policy to leadership.
• Use professional judgment to determine when to escalate requests to pharmacists or medical directors.
• Identify and report fraud, waste, abuse, or policy violations according to guidelines.
• Recognize and communicate individual and team training opportunities.
• Meet service, quality, and productivity standards while completing assigned work.
• Utilize pharmacy and health plan systems, claims processing platforms, and Microsoft Office efficiently.
• Navigate and leverage multiple systems and tools to deliver high-quality service and meet regulatory and contractual obligations.

Essential Skills

• Bachelor's degree or at least 2 years of experience as a pharmacy technician in a managed care environment.
• Oregon Pharm Tech License required.
• Current Basic Life Support (BLS) certification through the American Heart Association required.
• Advanced Excel skills required, including the ability to build pivot tables and utilize advanced functions.
• Epic experience required.
• Strong working knowledge of medical terminology, HCPCS, CPT, and ICD-10 coding applications.
• Knowledge of confidentiality guidelines and compliance with HIPAA, state and federal pharmacy law, and health insurance regulations.
• Ability to monitor for and identify fraud, waste, and abuse, and report concerns per established policies.
• Excellent verbal and written communication skills.
• Strong interpersonal and phone skills with the ability to build relationships with providers, internal teams, members, and office staff.
• Ability to organize and catalog pharmaceutical information related to conditions, procedures, and billing.
• Strong ability to work independently while prioritizing and organizing multiple tasks and projects.
• Proven analytical, problem-solving, research, and database maintenance skills.
• Ability to manage high workloads and competing priorities in a fast-paced, changing environment.
• High level of accuracy and attention to detail.
• Ability to perform pharmaceutical calculations quickly and accurately.
• Ability to obtain, interpret, and apply medical and drug-related information necessary to process requests.
• Ability to learn and strictly follow established medical policies, protocols, and systems.
• Strong professional judgment to identify when escalation to a pharmacist or medical director is required.

Additional Skills & Qualifications

• Knowledge of pharmacy benefits management and medication therapy management.
• Experience in managed care, including handling prior authorization review and mandatory audits across all lines of business (Medicare, Medicaid, Commercial Fully Insured, Individual, ASO).

Work Environment

This position is 100% remote, located in Portland, OR. The schedule involves working Monday through Friday from 8:00 AM to 5:00 PM, with on-call duties 2-3 weekends per year. The role serves a diverse patient population, including neonate, pediatric, adolescent, adult, and geriatric members. The work environment requires competency in interpreting member self-reports or behaviors with an understanding of cognitive, physical, emotional/psychosocial, and chronological maturation processes. The individualized treatment of members reflects an understanding of their needs and the range of necessary care. Benefits include six paid holidays, medical, dental, vision, life, AD&D, disability coverages, and participation in a 401(k) plan.

Job Type & Location

This is a Contract position based out of Portland, OR.

Pay and Benefits

The pay range for this position is $22.00 - $33.00/hr. 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