Remote Pharmacy Technician Opportunity!

Remote Pharmacy Technician opportunity! Job Description This Pharmacy Technician role supports multiple pharmacy operations areas, including formulary management, prior authorization, pharmacy audit and recovery, Medicare Part D and Part B, appeals, Medicare Part D operations, state health programs pharmacy operations, and pharmacy service center functions. You will review and process requests from physicians, medical groups, pharmacies, and members for prescription drugs and pharmacy benefits, research and resolve issues, and collaborate closely with clinical pharmacists and other clinical and operational teams to ensure accurate, compliant, and timely service. Responsibilities Review and process formulary change requests from health plans and submit and maintain these requests in the pharmacy claims processing system. Generate, maintain, and review formulary status grids and use reports to perform audits and quality checks on formulary status for accuracy and contract compliance. Assist clinical pharmacists with formulary database maintenance and updates to the company website. Perform a variety of pharmacy audit and recovery assignments, including reviewing paid claims for quantity and billing discrepancies and communicating findings to pharmacies. Fax inquiries to pharmacies related to audit findings, respond to incoming calls and faxed correspondence from pharmacies, and update the Access database with phone, fax, and email interactions. Handle member inquiry calls regarding pharmacy benefits, including prior authorization requests, and maintain expert knowledge of Medicare pharmacy benefits, formularies, and applicable regulations. Educate members about their specific pharmacy benefits and available options, including submitting prior authorization requests, and process member-submitted claims. Review requests from physicians and pharmacies for non-formulary drugs, drugs requiring prior authorization, drugs exceeding quantity or cost limits, or those needing assistance with online claim processing. Assign, enter, and document prior authorizations in the appropriate claims processing systems and answer phone calls related to prior authorization inquiries. Research and resolve prior authorization issues using appropriate reference materials and maintain a thorough understanding of pharmacy and medical benefits. Review and process PDE files for Medicare Part D operations, research and resolve related issues, and assist with pharmacy claims correction projects. Perform audits and quality checks on active prior authorization claims and assist with identifying and correcting eligibility and group issues, including processing member claims. Serve as a liaison to internal and external departments for state health program pharmacy operations and support operational issue resolution from prior authorization, appeals and grievances, and member or provider services. Prepare and review various operational reports and audits, perform formulary management functions for state health programs, and support quarterly formulary updates to websites, databases, and benefit maintenance. Maintain prior authorization database files, process Medi-Cal DMRs, assist with state health program clinical projects, and support Medi-Cal prior authorizations. Assist with the implementation of regulatory changes and participate in maintaining consistent processes for developing, implementing, communicating, and training on new or updated policies and procedures. Collaborate with business units and departments to ensure end-to-end process connectivity and appropriate handoffs across policies and procedures spanning multiple departments. Provide support and monitoring to help ensure compliance of first tier, downstream, and related entities and assist with department preparation for internal and external audits, including building case files, universes, and evidence of compliance. Identify the validity of appeals and route non-valid appeals to the appropriate department while verifying drug, dosage, quantity, provider, and diagnosis information. Research appeals using formularies and prior authorization criteria to determine if additional information is needed and reach out to providers and members to clearly communicate required information. Complete other appeal-related tasks as assigned. Track and triage coverage determination and prior authorization requests for Medicare Part D and Part B, determine when pharmacist review is required, and obtain verbal authorizations and detailed clinical information from prescribers. Approve coverage determination and prior authorization requests based on defined criteria and enter and document decisions in the PBM system while notifying providers and members. Respond to client inquiries regarding authorization approvals and PBM online processes, refer coverage determination requests for specialty drugs to delegated vendors or clients, and contact providers for additional information to facilitate reviews. Notify physicians, providers, and members of coverage determination decisions and perform other duties as assigned. Ensure compliance with all applicable policies and standards in daily work. Essential Skills High school diploma or GED. At least 1 year of experience as a Pharmacy Technician. Experience in pharmacy operations such as data entry, prior authorization, or related pharmacy functions. Ability to review and process prescription drug and pharmacy benefit requests accurately and efficiently. Strong attention to detail for auditing claims, reviewing formulary status, and maintaining accurate records. Proficiency in handling phone-based customer or member inquiries and providing clear, helpful information. Capability to research and resolve issues using reference materials, formularies, and benefit criteria. Ability to interpret and apply pharmacy and medical benefit information. Strong organizational skills to manage multiple tasks such as prior authorizations, appeals, audits, and reporting. Effective written and verbal communication skills for interacting with members, providers, pharmacies, and internal teams. INTERESTED IN THIS ROLE? SEE BELOW TO BE IMMEDIATELY CONSIDERED: I am scheduling phone interviews as early as today. All candidates will be considered immediately within 24 hours of applying directly to Fathima HOW TO APPLY DIRECTLY: Email your updated resume, brief intro about your interest, preferred method of communication for you (i.e., call, email, text) to fam @actalentservices.com or CALL- 904 530 5415 Job Type & Location This is a Contract to Hire position based out of Fort Worth, TX. Pay and Benefits The pay range for this position is $20.00 - $24.00/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) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Sep 4, 2026. 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. 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 [email protected] for other accommodation options. San Francisco Fair Chance Ordinance: 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 with arrest and conviction records. Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.