Job Title: Remote Pharmacy Technician

Job Description

We are seeking a dedicated Pharmacy Technician to join our team, focusing on supporting Medicare and Medicaid patients through the prior authorization process. This role involves two primary functions: intake and technical review. Initially, you will manage the intake of prior authorizations, setting up cases in our system before forwarding them for review. You'll also receive training for tech review, where you'll assess coverage criteria, approve or deny authorizations, and make clinical determinations based on insurance and medical documents.

Responsibilities

• Handle intake of prior authorization requests, setting up cases in the system.
• Conduct technical reviews to determine coverage eligibility.
• Approve or deny medication coverage based on clinical criteria.
• Read and interpret criteria, SOPs, insurance documents, and medical records.
• Provide excellent customer service and manage communications effectively.
• Work independently and remotely, ensuring HIPAA compliance.

Essential Skills

• Pharmacy technician certification.
• Prior experience in managed care and claims processing.
• Proficient in data entry and computer skills.
• Ability to work remotely and independently.
• Strong customer service skills.

Additional Skills & Qualifications

• Experience handling customer service calls.
• Ability to control and redirect conversations as needed.

Work Environment

This position is 100% remote, requiring a closed-door setting with limited distractions and HIPAA compliance. A strong WiFi connection is essential for remote work.