REMOTE Prior Authorization Technician

Job Title: Remote MedPharma Pharmacy Technician Job Description 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. Responsibilities

- Process MedPharma 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.

Essential Skills

- 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.

Additional Skills & Qualifications

- 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 skills, both verbal and written, for interacting with patients, providers, and internal teams.
- Ability to adapt to varying schedules, including evening and weekend shifts, and participate in rotating holiday coverage.
- Comfort working in a structured, process-driven environment with clear SOPs and performance expectations.
- Interest in long-term, permanent opportunities that offer holidays, paid time off, flexibility, and benefits.
- Self-motivated mindset with the ability to stay focused and productive in a closed-door, distraction-free setting.

Work Environment This position is 100% remote and requires working from a closed-door setting with limited distractions to maintain a HIPAA-compliant environment. You must have strong, reliable Wi-Fi and the ability to work effectively from home using computer-based systems and digital documentation. Training takes place Monday through Friday from 10:00 a.m. to 6:30 p.m. EST. After training, you will work one of two schedules: a SundayThursday schedule (preferred hours of 12:008:30 p.m. or 12:309:00 p.m. EST, with Sunday hours of 8:00 a.m.4:30 p.m. EST) or a TuesdaySaturday schedule (TuesdayFriday preferred hours of 12:309:00 p.m. EST and Saturday hours of 8:00 a.m.4:30 p.m. EST). Holidays are covered on a rotating basis with other team members. Lunch breaks range from 30 minutes up to an hour, depending on scheduling and business needs. The culture emphasizes a high internal satisfaction score, flexibility, and benefits in a professional, supportive remote work setting.
Job Type & Location
This is a Contract to Hire position based out of San Antonio, TX.
Pay and Benefits
The pay range for this position is $20.00 - $23.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. 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)
Short and long-term disability
Health Spending Account (HSA)
Transportation benefits
Employee Assistance Program
Time Off/Leave (PTO, Vacation or Sick Leave)
Job Type & Location
This is a Contract to Hire position based out of San Antonio, TX.
Application Deadline
This position is anticipated to close on Nov 6, 2026.
Workplace Type
This is a fully remote position. About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.

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Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the
city and county of San Francisco, we will consider for employment qualified applicants
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