REMOTE Prior Authorization Technician

This remote Pharmacy Technician role focuses on processing and reviewing medication prior authorizations for Medicare and Medicaid patients, with a primary emphasis on Medicare. You will handle both intake and technical review functions, ensuring accurate data entry, thorough evaluation of coverage criteria, and clear clinical determinations on medication approvals and denials. The position offers a strong culture, flexibility, and benefits in a fully remote, HIPAA-compliant work environment.

• Process Med Pharma prior authorizations for Medicare and Medicaid patients, primarily Medicare, in accordance with established procedures and guidelines.
• Perform intake duties by setting up prior authorization cases in internal systems accurately and efficiently.
• Route completed intake cases to the review team and, once trained, handle technical review responsibilities.
• Conduct technical reviews of prior authorization cases to determine medication coverage, including approval, denial, or partial coverage decisions.
• Read and interpret coverage criteria, standard operating procedures (SOPs), insurance documents, and medical documents to determine eligibility.
• Make clinical determinations regarding whether medications are approved or denied based on available information and coverage policies.
• Ensure all data entry related to prior authorizations, claims, and patient information is accurate, complete, and compliant with regulations.
• Provide customer service over the phone, handling inbound and outbound calls related to prior authorizations and coverage decisions.
• Control and guide conversations with callers, redirecting as needed to gather required information and maintain a professional, efficient interaction.
• Use computer systems and software tools to manage cases, document decisions, and track workflow in a remote environment.
• Work independently in a remote setting while adhering to HIPAA requirements and maintaining confidentiality of patient information.
• Collaborate with team members on rotating holiday coverage and shared responsibilities to ensure consistent service levels.
• Participate in training and ongoing education to stay current on managed care, pharmacy practices, and prior authorization processes.

• Active Pharmacy Technician certification (such as CPhT) with demonstrated experience as a Pharmacy Technician.
• Hands-on experience in managed care or a similar environment involving insurance, claims, and coverage determinations.
• Prior experience working in a pharmacy setting, with familiarity in medication workflows and prior authorization processes.
• Proficiency in data entry with strong attention to detail and accuracy in handling patient and insurance information.
• Customer service experience over the phone, including the ability to handle calls professionally and maintain composure.
• Skill in controlling and guiding conversations, including redirecting discussions to obtain necessary information and resolve issues.
• Strong computer skills and comfort working with multiple systems and digital documentation.
• Proven ability to work remotely and independently while managing workload and meeting performance expectations.
• Ability to read and interpret insurance documents, SOPs, and medical documentation to support clinical and coverage decisions.
• Commitment to maintaining HIPAA compliance and safeguarding sensitive patient information in a remote environment.

• Experience with prior authorization processing in a managed care or pharmacy environment.
• Experience in claims-related work, including understanding of coverage rules and insurance terminology.
• Strong interpersonal and communication…