REMOTE Pharmacy Technician

Job Title:

Remote Med Pharma Pharmacy Technician

Job Description

This role is a fully remote Pharmacy Technician position supporting Med Pharma operations for Medicare and Medicaid patients, with a strong focus on Medicare. You will manage prior authorizations from intake through technical review, ensuring accurate data entry, thorough clinical evaluation, and clear communication with patients and providers. The position offers a supportive culture, flexibility, and benefits, while allowing you to work independently in a compliant home office environment.

Responsibilities

+ Handle the intake process for Med Pharma prior authorizations by accurately setting up prior authorization cases in internal systems.

+ Ensure all required information for each prior authorization is collected, documented, and submitted correctly for review.

+ Transition prior authorization cases from intake to the review team in a timely and organized manner.

+ Perform technical review of prior authorization cases after training, including assessing coverage eligibility for medications.

+ Read and interpret criteria, standard operating procedures (SOPs), insurance documents, and medical documents to determine medication coverage.

+ Make clinical determinations on whether medications are approved, denied, or covered in any capacity based on established guidelines.

+ Apply managed care and pharmacy knowledge to evaluate prior authorization requests and support appropriate patient care.

+ Conduct data entry with a high level of accuracy and attention to detail in all pharmacy and insurance systems.

+ Provide professional customer service over the phone, handling calls from patients, providers, and other stakeholders.

+ Control and guide conversations effectively, redirecting as needed to gather information, clarify issues, and resolve concerns.

+ Work independently in a remote environment while adhering to HIPAA and other privacy and security requirements.

+ Collaborate with team members virtually, including participating in rotating holiday coverage as scheduled.

+ Maintain productivity and quality standards during both intake and review functions.

+ Follow all internal policies, procedures, and SOPs related to Med Pharma prior authorization processing.

+ Participate in training and ongoing development to expand from intake responsibilities into full technical review capabilities.

Essential Skills

+ Active pharmacy technician certification (such as CPhT) or equivalent credential.

+ Previous experience working as a Pharmacy Technician.

+ Experience in managed care or similar healthcare insurance environments.

+ Pharmacy experience, including familiarity with medications and pharmacy operations.

+ Prior authorization experience, particularly with Medicare and Medicaid patients.

+ Strong data entry skills with a focus on accuracy and efficiency.

+ Customer service experience over the phone, including handling calls and supporting patients or providers.

+ Ability to control conversations, manage call flow, and redirect discussions when necessary.

+ Proficient computer skills and comfort working with multiple systems and digital documents.

+ Ability to work remotely and independently while meeting performance expectations.

+ Ability to read and interpret clinical criteria, SOPs, insurance documents, and medical documents.

+ Strong attention to detail and ability to follow structured processes.

Additional

Skills & Qualifications

+ Experience handling Medicare and Medicaid prior authorizations.

+ Experience in claims or managed care pharmacy settings.

+ Demonstrated ability to provide high-quality customer service in a healthcare or pharmacy environment.

+ Comfort working in a highly regulated environment with strict privacy and security requirements.

+ Ability to adapt from an intake-focused role into a technical review role through training.

+ Strong organizational skills to manage multiple cases and tasks in a remote setting.

+ Ability to maintain focus and productivity in a closed-door, distraction-free workspace.

+ Interest in contributing to a high-scoring, positive workplace culture.

+ Flexibility to work rotating holiday schedules with other team members.

Work Environment

This position is 100% remote and requires working in a closed-door setting with limited distractions to maintain HIPAA compliance. You must have strong, reliable Wi-Fi and the ability to work independently from a secure home office. Training is conducted Monday through Friday from 10:00 a.m. to 6:30 p.m. EST. After…