Pharmacy Call Center Representative

PharmPix Corp; Guaynabo (PR); On-site; USD 32,000 - 42,000; Full time

Job summary

PharmPix Corp is seeking a Pharmacy Help Desk Call Center Representative to handle incoming and outbound calls from providers, beneficiaries and pharmacies, delivering compliant support on claims, reimbursement, and payment processes.

The role requires a Pharmacy Technician background, bilingual Spanish/English, and the ability to research issues, document inquiries, and coordinate with internal departments. Evening or weekend work may be required.

Qualifications

• Pharmacy Technician, Technical or Associate Degree.
• Puerto Rico Board of Pharmacy Technician Registry Certificate (CPhT) preferred.
• 1-2 years customer service or call center experience in a healthcare environment preferred.

Responsibilities

• Answer incoming pharmacy calls about claims, reimbursement, payment and related information.
• Follow call center scripts and company performance metrics to resolve issues.
• Document inquiries in Service Desk, OneArk and email systems.
• Route cases to internal departments or health insurance carriers.
• Guide pharmacies/providers/beneficiaries on claim transmission and payment processes.
• Monitor BACMAN Alert for rejection management at the point of sale.
• Research issues and provide solutions; maintain professional communication.

Skills

Bilingual Spanish/English

Phone etiquette

Written communication

Active listening

Time management

Multitasking

Team collaboration

Software navigation

Education

Pharmacy Technician

Associate Degree

Tools

Service Desk

OneArk

Email systems

Job description

The Pharmacy Help Desk Call Center Representative reports to the Pharmacy Help Desk Call Center Supervisor and is responsible to provide a customer service by telephone of incoming and outbound calls to providers, beneficiaries and pharmacies.

ESSENTIALS ROLES AND RESPONSIBILITIES

• Answer incoming pharmacy calls regarding issues related to a claim transaction, reimbursement, payment, and other required information in accordance with PharmPix Pharmacy Help Desk Call Center performance metrics.
• Answer incoming providers' and beneficiaries' calls following Call Center scripts, in a timely matter and in accordance with PharmPix call center performance metrics.
• Answer incoming calls and perform outbound calls according to HIPAA and Pharmacy Laws Standards.
• Identify pharmacies, providers and beneficiaries needs, clarify information, research every issue and providing solutions.
• Document all inquiries in the Customer Service Management Applications such as, Service Desk, OneArk and email.
• Route the case to the corresponding internal department or the appropriate Health Insurance Carrier.
• Guide pharmacies, providers and beneficiaries regarding the process of claim transmission, reimbursement and payment.
• Constantly monitors the BACMAN Alert Application to ensure proper management of rejections at point of sale.
• Evaluate on an individual basis to determine if the patient meets the criteria for a coverage determination for alerts such as DURs (Drug Utilization Reviews), HMO (Health Maintenance Organization) among other rejections evaluations required by business.
• Identify system issues and route to the corresponding internal department.
• Make outbound calls to pharmacies, providers and beneficiaries if necessary.
• Support all Quality Management Program initiatives.
• Perform Special projects and/or other duties assigned by the Operations Manager and or Pharmacy Help Desk Call Center Supervisor.

TRAINING & EDUCATION

• Pharmacy Technician, Technical or Associate Degree

LICENSURE / CERTIFICATION

• Puerto Rico Board of Pharmacy Technician Registry Certificate (CPhT), or prospect.

PROFESSIONAL EXPERIENCE

• 1 - 2-year customer service or call center experience and healthcare environment (Preferable).

PROFESSIONAL COMPETENCIES

Knowledge:

• Fully Bilingual (Spanish / English written and verbal).
• PC skills (Microsoft System)/System oriented.

Skills:

• Excellent phone, written, active listening and follow-through skills.
• Skill in analyzing situations accurately and taking effective action.
• Time Management Skills: Establishing priorities and accomplishing tasks in a timely manner.
• Ability to work with others to reach a solution.
• Be able to toggle between several software programs.
• Demonstrated effective organizational skills.

Abilities:

• Able to effectively interact with internal departments, PharmPix clients, members and other healthcare professionals.
• Ability to work with others to reach a solution.
• Be able to toggle between several software programs.
• Ability to work in a fast-paced environment and multitask.

PHYSICAL AND MENTAL DEMANDS

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear, sitting, standing and walking.
• The position requires that weight be lifted and force be exerted up to 25 pounds.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ENVIRONMENTAL AND WORKING CONDITIONS

• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. Require evening or weekend work.

PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans