Job Title: Pharmacy Technician Remote Position

Job Description

As a member of the Prior Authorization Operations team, you will process prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments. You will use various business applications (MedAccess, FileNet, RightFax, etc.) to analyze, obtain information, and enter prior authorization data necessary for claims adjudication. You will utilize reasoning skills to identify missing information and make prior authorization processing determinations based on clinical protocols and client guidelines. Interaction with internal and external customers to provide and obtain information and ensure the delivery of outstanding service and quality is essential. This is a full time position that is W2-this is not a 1099 contract. Full benefits provided.

ResponsibilitiesProcess and finalize prior authorization requests within clients’ turnaround time and performance guarantees utilizing guidelines.Enter prior authorizations into the system and prioritize requests.Check formulary alternatives and review tried and failed medications.Handle inbound calls and some follow-up calls.Answer calls and questions on prior authorization, general questions, and some confidential information.Provide great customer service with high attention to detail and accurate information entry.Utilize drug references and verify the drug being requested is indicated and approved for the condition.Document all related information regarding the prior authorization approval or non-approval.Respond to requests by faxing the status of the prior authorization to the physician or pharmacy.Conform to defined roles and responsibilities and rules of engagement between prior authorization processing and clinical decision making.Partner with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing.Achieve prior authorization processing productivity and accuracy standards.Analyze, research, and resolve prior authorization processing issues as appropriate, including making written or telephone inquiries to obtain information from clients, members, physicians, or pharmacies.Coordinate notifications to members, physicians, and pharmacies as required to obtain missing information, manage pended requests, and communicate prior authorization determinations.Document prior authorization-related information and status.Make outbound calls to obtain information and answer questions about prior authorization status.Essential SkillsCurrent Pharmacy Technician License and/or CPhT certification without restriction.Understanding of managed pharmacy benefit concepts including formularies, prior authorizations, edits, and claim adjudication.Working knowledge of customer service in a retail/outpatient pharmacy environment.Familiarity with pharmacy software data submission requirements.Data entry skills.Intermediate knowledge of MS Office/Word, Excel, and Outlook.Aptitude for new programs.Experience with Windows-based database programs.Additional Skills & QualificationsMust successfully complete one of the national certification exams or obtain state licensure in a U.S. State or Territory.Demonstrates ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals, and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.Work Environment

This is a remote position with equipment provided. You will need a quiet workspace and a high-speed internet connection. Various schedules are available, with hours needing to be covered from 5am-11pm MST. Confirmed shifts include: 7am-3:30pm EST, 7am-3:30pm MST, 9am-5:30pm MST, 9am-5:30pm PST, 2:30pm-11pm PST. Benefits include Health/Dental/Vision/Wellness Programs, Paid Time Off, Company Paid Holidays, Incentive Compensation, 401K with Company match, Life and Disability Insurance, Tuition Reimbursement, and an Employee Referral Bonus.

Pay and Benefits

The pay range for this position is $23.50 - $23.50/hr.

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)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Mar 25, 2025.

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 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

Hiring diverse talent Maintaining an inclusive environment through persistent self-reflection Building a culture of care, engagement, and recognition with clear outcomes Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.