We are looking for a responsible Health Professional-Pharmacy Call Center Representative. The Health Professional-Pharmacy Call Center Representative manages telephone calls and Prior Authorizations from pharmacies and providers related to pharmacy benefits, authorization requests, drug use review, among others, to ensure that claims are correctly and timely adjudicated. It also collaborates with Team Leader and Pharmacy Supervisor with assigned tasks

Essential Functions:

1. Answers and manages telephone calls from pharmacies and providers in a timely, confidential and courteous manner.
2. Documents calls and/or drug requests with complete follow-up history of the patient through electronic records.
3. Provides orientation to pharmacies regarding pharmacy benefits.
4. Performs system overrides (e.g., prior authorization) on the PBM claims processing system to ensure that claims are correctly adjudicated.
5. Assists pharmacies claim processing.
6. Assist in the training of pharmacy representatives.
7. Collaborate with client special projects such as and limited to analysis of specialty drug protocols and non-formulary drugs.
8. Assist with internal/external audit request.

9. Collaborate as remote first responders in an emergency event.

10. Identify possible errors in PA Hub protocols vs. written protocols to make recommendations to MC-21.

11. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.

12. In addition, all other duties assigned by the manager and/or supervisor.

Education:

• Pharmacy Technician Course of accredited school.
• Possess an active professional unrestricted Pharmacy Technician License in good standing to practice in Puerto Rico territory.

Experience:

• Minimum 2 years’ experience in retail pharmacy preferred.

Knowledge:

• Basic knowledge of physical and mental pharmacotherapies, in order to make accurate assessments of clinical cases.
• Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.

Job Type: Full-time

Pay: $10.20 - $11.70 per hour

Benefits:

• 401(k) matching
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Tuition reimbursement

Physical setting:

• Call center

Schedule:

• 8 hour shift
• Holidays
• Monday to Friday
• Overtime
• Weekend availability

COVID-19 considerations:
All customers are required to wear a mask, curbside pickup available, common surfaces are sanitized regularly, vaccination requirements.

Experience:

• Pharmacy Technician: 1 year (Preferred)
• Customer service: 1 year (Preferred)

Work Location: In person

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