REMOTE Pharmacy Technician

Remote Pharmacy Technician – Prior Authorization

This role focuses on supporting Medicare and Medicaid patients by processing and reviewing medication prior authorizations in a fully remote environment. You will start with intake of prior authorization requests and be trained to perform technical reviews, making clinical coverage determinations based on established criteria, SOPs, and insurance and medical documentation. The position combines detailed data entry, managed care pharmacy knowledge, and customer service over the phone to ensure patients receive timely and accurate decisions regarding their medications.

Responsibilities

• Process the intake of Med Pharm prior authorization requests by accurately setting up prior authorizations in internal systems.
• Route completed intake cases to the review team and, once trained, assume responsibility for technical review of prior authorization cases.
• Review prior authorization cases to determine medication coverage, including approval, denial, or partial coverage decisions.
• Carefully read and interpret coverage criteria, standard operating procedures (SOPs), insurance documents, and medical documents to assess eligibility.
• Make clinical determinations on whether medications are approved or denied based on established guidelines and managed care policies.
• Perform accurate and timely data entry related to claims, prior authorizations, and patient information.
• Provide professional customer service over the phone, handling calls from patients and providers regarding prior authorization status and requirements.
• Control and guide conversations on calls, redirecting as needed to maintain focus and provide clear, concise information.
• Work independently in a remote environment, maintaining productivity and adherence to performance and quality standards.
• Ensure all work complies with HIPAA and other privacy and security requirements while working in a closed-door, distraction-limited setting.
• Collaborate with team members to support rotating holiday coverage and flexible scheduling needs.
• Participate in training and apply new processes, criteria, and system updates to daily work.

Essential Skills

• Active pharmacy technician certification (such as CPhT).
• Hands-on experience as a pharmacy technician, preferably in a managed care or prior authorization setting.
• Experience with managed care and pharmacy operations, including working with Medicare and Medicaid populations.
• Demonstrated prior authorization experience, including intake, review, or claims-related activities.
• Strong data entry skills with high accuracy and attention to detail.
• Proficiency with computer systems and applications required for remote work and prior authorization processing.
• Customer service experience over the phone, including handling inbound and outbound calls.
• Ability to control conversations, manage difficult calls, and redirect discussions to maintain professionalism and clarity.
• Capability to work remotely and independently while meeting performance expectations.
• Solid understanding of pharmacy terminology and basic clinical concepts related to medication coverage and eligibility.

Additional Skills & Qualifications

• Experience in managed care pharmacy environments, including health plans or pharmacy benefit management.
• Familiarity with claims processing and insurance coverage criteria.
• Comfort reading and interpreting SOPs, insurance policies, and medical documentation.
• Strong organizational skills and ability to manage multiple prior authorization cases simultaneously.
• Excellent written and verbal communication skills for documentation and customer interactions.
• Ability to adapt to flexible schedules, including evenings, weekends, and rotating holiday coverage.
• Interest in working in a high-culture,…