Remote Pharmacy Technician

Remote Pharmacy Technician - Prior Authorization (EST Time Zone)

Job Description

This remote Pharmacy Technician role focuses on reviewing prior authorization requests and making coverage determinations for a pharmacy services department within a large health insurance organization. You will evaluate requests for a wide range of medications and health plans, document decisions in the pharmacy benefit management (PBM) system, and collaborate closely with pharmacists for final review. This position offers limited phone work, long-term career potential, and the opportunity to transition to a permanent role with benefits.

Responsibilities

+ Review prior authorization requests for prescription medications across multiple health plans and drug types.

+ Apply established clinical and coverage criteria to determine whether to approve or deny prior authorization requests.

+ Forward all coverage determinations to a pharmacist for final review and sign-off.

+ Track and manage coverage determination requests to ensure timely processing and resolution.

+ Enter all decisions and supporting information accurately into the PBM system and other internal platforms.

+ Obtain verbal authorizations from prescribers and other stakeholders as needed.

+ Request and collect detailed clinical information from prescribers to support coverage determinations.

+ Notify providers, members, and other stakeholders of decision outcomes in a clear and timely manner.

+ Respond to client inquiries related to prescription benefits, prior authorizations, and coverage decisions.

+ Refer requests involving specialty medications or complex cases to the appropriate specialty pharmacy or internal team.

+ Contact providers for additional information or clarification when documentation is incomplete or unclear.

+ Assist with inbound and outbound patient or physician calls when needed, with an emphasis on outbound communication.

+ Handle prescription benefit-related questions and issues in a professional, customer-focused manner.

+ Use multiple computer systems and screens simultaneously to research cases, document actions, and update records.

+ Maintain accurate, detailed records of all interactions, decisions, and supporting documentation.

+ Meet productivity, quality, and accuracy metrics while adhering to all applicable policies and procedures.

+ Participate fully in remote training sessions, apply learned processes, and adapt to updates in workflows or criteria.

+ Protect confidential member and provider information and follow all applicable privacy and security guidelines.

Essential Skills

+ High school diploma or GED.

+ Current registration as a pharmacy technician in the state of residence.

+ National certification as a pharmacy technician (e.g., PTCB or NHA).

+ Current Pharmacy Registration and Certification as required by the state of operation.

+ Experience working as a pharmacy technician in retail, hospital, PBM, call center, or specialty pharmacy environments.

+ Demonstrated experience with prior authorization processes and coverage determinations for prescription benefits.

+ Strong computer skills, including proficiency with basic computer operations and data entry.

+ Proficiency with Microsoft Office applications, including Outlook.

+ Ability to work effectively with multiple screens and systems simultaneously.

+ Strong attention to detail and accuracy in reviewing clinical information and entering data.

+ Effective customer service skills for interacting with providers, members, and internal teams.

+ Ability to work Monday-Friday between 8:00 a.m. and 8:00 p.m. in the local time zone, with rotating weekend and some holiday coverage.

+ Reliable high-speed Wi-Fi suitable for a professional remote work environment.

+ Ability to work independently in a dedicated home office space with a closed door.

Additional

Skills & Qualifications

+ National pharmacy technician certifications such as PTCB or NHA.

+ Experience working with Medicare and Medicaid prescription benefits.

+ Background in retail pharmacy, hospital pharmacy, specialty pharmacy, PBM, or call center environments.

+ Experience handling prescription benefits and prior authorization workflows in an insurance or managed care setting.

+ Strong written and verbal communication skills for documenting decisions and communicating with providers and members.

+ Comfort working with multiple systems and adapting to new technologies and software platforms.

+ Ability to meet performance metrics and quality standards in a high-volume,…