Cvs Remote Pharmacy Jobs (NOW HIRING)

A-Line Staffing is actively searching for Multiple Pharmacy Techs/Prior Authorization reps for a major healthcare company located in the Kissimmee, FL surrounding area. This is an exciting opportunity with a client that is looking to move fast for the right candidate.

****Must have STATE LICENSE******

Remote Prior Authorization Pharmacy Technician

Location: Remote (United States)
Job Type: Full-Time
Schedule: Monday – Friday (Shift varies based on business needs)
Department: Pharmacy Operations / Prior Authorization

Position Summary

We are seeking a detail-oriented and customer-focused Remote Prior Authorization Pharmacy Technician to join our growing Pharmacy Operations team. In this role, you will work closely with pharmacists, healthcare providers, insurance companies, and patients to facilitate timely medication approvals and ensure members receive appropriate prescription therapies.

The ideal candidate has experience with prior authorization, benefits verification, pharmacy claims, insurance eligibility, PBM operations, and high-volume inbound/outbound call center environments. This position requires exceptional communication skills, strong attention to detail, and the ability to multitask while maintaining productivity and quality standards in a fast-paced remote environment.

Essential Responsibilities

• Process and review prior authorization requests for specialty and retail medications in accordance with payer guidelines.
• Perform comprehensive benefits verification and insurance eligibility reviews for Commercial, Medicare, Medicaid, and other government-sponsored health plans.
• Review pharmacy claims, formulary requirements, step therapy, quantity limits, and prior authorization criteria.
• Communicate with physicians, provider offices, pharmacies, patients, and insurance carriers to obtain required clinical documentation.
• Conduct high-volume inbound and outbound calls regarding medication approvals, authorization status, prescription coverage, and reimbursement inquiries.
• Coordinate with pharmacists to ensure complete and accurate documentation for medication review.
• Research and resolve rejected pharmacy claims, authorization delays, and medication access barriers.
• Document all case activity accurately within pharmacy systems while maintaining HIPAA compliance.
• Monitor pending authorizations and perform timely follow-up to prevent delays in patient care.
• Review medical records and clinical documentation to support medication approval decisions.
• Escalate urgent or complex cases to pharmacists or clinical staff as appropriate.
• Meet daily productivity, quality, and turnaround time expectations while maintaining excellent customer service.
• Maintain confidentiality of protected health information (PHI) and comply with all HIPAA and company policies.

Required Qualifications

• High School Diploma or GED required.
• Current Pharmacy Technician registration or certification as required by state law.
• National Pharmacy Technician Certification (PTCB or ExCPT) preferred.
• Minimum 1 years of Pharmacy Technician experience.
• Minimum 1 year of Prior Authorization, Benefits Verification, or PBM experience preferred.
• Experience working remotely preferred.
• Strong understanding of pharmacy terminology and medication names.
• Knowledge of Commercial, Medicare Part D, and Medicaid pharmacy benefits.
• Experience with pharmacy claims adjudication and insurance verification.
• Excellent computer skills with Microsoft Office (Word, Excel, Outlook).
• Ability to navigate multiple systems simultaneously.
• Strong written and verbal communication skills.

Preferred Experience

• Pharmacy Benefit Management (PBM)
• Prior Authorization
• Specialty Pharmacy
• Mail Order Pharmacy
• Central Fill Pharmacy
• Retail Pharmacy
• Hospital Pharmacy
• Medication Therapy Management (MTM)
• Appeals and Coverage Determinations
• Insurance Claims Processing
• Reimbursement Support
• Medicare Part D
• Commercial Insurance
• Medicaid
• Pharmacy Call Center
• Electronic Medical Records (EMR/EHR)

Core Competencies

• Prior Authorization Processing
• Benefits Verification
• Insurance Eligibility Review
• Pharmacy Claims Processing
• Pharmacy Operations
• Prescription Coverage Research
• Medication Access Support
• Provider Outreach
• Member Services
• High-Volume Inbound & Outbound Calling
• Documentation Accuracy
• Time Management
• Critical Thinking
• Attention to Detail
• Customer Service Excellence
• Problem Solving
• HIPAA Compliance
• Team Collaboration

Technology Requirements

• High-speed internet connection.
• Dedicated, private workspace free from distractions.
• Ability to work securely in a remote environment.
• Comfortable using multiple computer monitors and healthcare software simultaneously.

ead, write, speak and understand English Preferred Qualifications: Previous technician experience.