Job Title: Pharmacy Technician - Appeals DepartmentJob Description
This role focuses on supporting the appeals process for Medicare and Medicaid patients by reviewing denied prior authorizations, gathering additional information, and coordinating with pharmacists for final determinations. The Pharmacy Technician communicates directly with members, many of whom are elderly and may be frustrated about medication denials, and helps ensure that each case is handled thoroughly, accurately, and with empathy.
Responsibilities
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Review denied prior authorization cases for Medicare and Medicaid patients, with a primary focus on Medicare members.
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Evaluate all available clinical and administrative information related to each denied prior authorization.
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Identify missing or incomplete information and proactively reach out to obtain the necessary details to support the appeal.
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Make 30-60 outbound calls per shift to members and other relevant parties, focusing on clear communication and efficient information gathering.
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Communicate with Medicare and elderly members who may be frustrated by medication denials, demonstrating patience, empathy, and professionalism.
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Explain the appeals process in a clear and respectful manner, helping members understand next steps and what information is needed.
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Document all interactions and updates accurately in the system to ensure a complete and compliant case record.
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Prepare and forward completed cases to pharmacists for final determination on whether to uphold or overturn the denial.
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Collaborate closely with pharmacists and other team members to support timely and accurate resolution of appeals.
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Maintain confidentiality of patient information and follow all applicable regulations and internal procedures.
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Use strong conversation control skills to guide calls, redirect discussions when necessary, and keep interactions focused and productive.
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Perform data entry tasks related to appeals, ensuring accuracy and completeness of all recorded information.
Essential Skills
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Experience working as a pharmacy technician or in a pharmacy-related role.
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Proficiency in data entry with strong attention to detail and accuracy.
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Demonstrated customer service experience over the phone, particularly in handling complex or sensitive conversations.
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Ability to handle a high volume of outbound calls (approximately 30-60 calls per shift).
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Strong communication skills, including the ability to explain processes clearly and listen actively to member concerns.
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Ability to control conversations, maintain focus, and redirect discussions when needed.
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Comfort working with Medicare and Medicaid populations, including elderly members who may be upset or frustrated.
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Ability to review and interpret information related to prior authorizations and appeals.
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Professionalism, patience, and empathy when dealing with members experiencing medication access issues.
Additional Skills & Qualifications
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Prior experience working in an appeals or prior authorization environment.
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Familiarity with medications commonly administered in a doctor's office, including injectable therapies.
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Experience collaborating with pharmacists or other clinical professionals.
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Strong organizational skills and the ability to manage multiple cases simultaneously.
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Comfort working with standardized procedures and regulatory requirements in a healthcare setting.
Work Environment
The Pharmacy Technician works in an appeals-focused environment that is structured and process-driven, with a strong emphasis on accuracy, regulatory compliance, and timely case resolution. The role involves primarily outbound phone work, making 30-60 calls per shift, and requires extended periods of time on the phone and at a computer performing detailed data entry and documentation. The position centers on supporting Medicare and Medicaid members, especially elderly individuals, and involves frequent interaction with pharmacists and other internal team members to move appeals through the review process. The environment values professionalism, clear communication, empathy, and a patient-focused approach to resolving medication access issues.
Job Type & Location
This is a Contract position based out of Atlanta, GA.
Pay and Benefits
The pay range for this position is $18.00 - $20.00/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 May 25, 2026.
About Actalent
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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.
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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.
