Pharmacy Help Desk Call Center Representative

POSITION SUMMARY

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

1. 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.
2. Answer incoming providers’ and beneficiaries’ calls following Call Center scripts, in a timely matter and in accordance with PharmPix call center performance metrics.
3. Answer incoming calls and perform outbound calls according to HIPAA and Pharmacy Laws Standards.
4. Identify pharmacies, providers and beneficiaries needs, clarify information, research every issue and providing solutions.
5. Document all inquiries in the Customer Service Management Applications such as, Service Desk, OneArk and email.
6. Route the case to the corresponding internal department or the appropriate Health Insurance Carrier.
7. Guide pharmacies, providers and beneficiaries regarding the process of claim transmission, reimbursement and payment.
8. Constantly monitors the BACMAN Alert Application to ensure proper management of rejections at point of sale.
9. 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.
10. Identify system issues and route to the corresponding internal department.
11. Make outbound calls to pharmacies, providers and beneficiaries if necessary.
12. Support all Quality Management Program initiatives.
13. 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).