Pharmacy Call Center Representative

RCM Technologies, Inc. | Life Sciences / Data & Solutions

San Juan, PR

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JOB DETAILS

SALARY

SKILLS

Adjudication, Aerospace Engineering, Aerospace and Defense, Analysis Skills, Behavioral Health, Biology, Call Centers, Call Volume, Centers for Medicare and Medicaid Services (CMS), Claims Processing, Communication Skills, Compensation and Benefits, Customer/Consumer Behavior, Documentation, Drug Therapy, Electronic Medical Records, Establish Priorities, Health Information Technology, Health Plan, Healthcare, Manufacturing/Industrial Processes, Market Segmentation, Medicaid, Medical Record System, Medicare, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, Microsoft Word, Multitasking, Operational Support, Organizational Development/Management, People Management, Pharmacy, Presentation/Verbal Skills, Problem Solving Skills, Psychiatry and Mental Health, Public/Media/Press/Analyst Relations, Regulations, Regulatory Compliance, Retail, Retirement Plan, Telephone Skills, Time Management, Willing to Travel, Writing Skills

LOCATION

San Juan, PR

POSTED

30+ days ago

Full Time - Direct Placement

Title: Health Professional 1-Pharmacy Call Center Representative
Compensation: Hourly $12.70 , there is a shift difference on Saturdays of $15.00 and Sundays $25.00 plus benefits.
Location: San Juan, PR (On-site)

Company Description:
Our client is a leading behavioral health organization headquartered in San Juan, Puerto Rico. With over two decades of experience, our client specializes in managing mental health services for populations covered by Medicaid, Medicare, and commercial health plans. The organization serves more than 1.3 million lives across the island through a robust network of providers and over 2,000 healthcare professionals

Position Summary:
The Pharmacy Call Center Representative plays a key role in supporting pharmacy operations by managing inbound calls and processing prior authorization requests. This position ensures accurate and timely adjudication of pharmacy claims while providing guidance to pharmacies and providers regarding benefits and claim procedures.

Responsibilities:

Call Management: Answer and manage a high volume of telephone calls from pharmacies and providers in a timely, confidential, and courteous manner.
Pharmacy Benefits Orientation: Provide accurate orientation and information to pharmacies and providers regarding patient-specific pharmacy benefits and formulary status.
Authorization Processing: Perform system overrides, including managing and processing non-clinical aspects of prior authorization (PA) and exception requests on the Pharmacy Benefit Manager (PBM) claims processing system.
Documentation: Accurately document all calls, drug requests, and follow-up history in the patient's electronic record (EHR/PBM system).
Training & Support: Assist in the training of new pharmacy representatives or other related staff.
Regulatory Compliance: Ensure all activities and documentation strictly comply with guidelines established by the Centers for Medicare and Medicaid (CMS) and other regulatory agencies specific to the Puerto Rico territory.

Qualifications:

Minimum of 2 years' experience in retail pharmacy is preferred.
Basic understanding of physical and mental pharmacotherapy.
Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook).
Strong verbal and written communication skills.
Excellent analytical and problem-solving abilities.
Ability to manage multiple tasks and prioritize effectively.
Ability to work independently and collaboratively in a fast-paced environment.
Willingness to travel independently and work evenings/weekends as needed.

Education :

Completion of a Pharmacy Technician course from an accredited institution.
Active, unrestricted Pharmacy Technician License in good standing in Puerto Rico.

Work Schedule

Must be available to work rotating shifts, including weekends and holidays.
Shifts are scheduled monthly, with weekly rotation.
Work hours range from 7:00 AM to 10:00 PM, across all seven days of the week.

Benefits:

" Medical plan after 30 days from the start date, effective the first day of the month
" Retirement plan after 30 days
" Vacation 15 days per year
" Sick leave 12 days per year
" Floating day 2 days per year (can be used after the 3-month probationary period), available 1 in January and 1 in July
" Life insurance based on annual salary
" $3,000 tuition reimbursement after 1 year with the companyEqual Opportunity Employer:
RCM is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Pay Transparency:
RCM believes in transparency and fairness in compensation. We are committed to providing our employees with competitive salaries that reflect their skills, experience, and contributions to our organization. As part of our commitment to pay transparency, we want to provide you with as much information as possible about our compensation practices.

About RCM:
RCM is publicly traded on Nasdaq under the symbol RCMT. RCM is a business and technology solutions provider with world-class talent in key market segments. We help design, build, and enable the Industries of Tomorrow, Today. Operating at the intersection of resources, critical infrastructure, and modernization of industries, RCM is a provider of services in Life Sciences, Data & Solutions (IT), Healthcare, Engineering, Aerospace & Defense, and Process & Industrial.

Disclaimer:
This job posting is intended to describe the general nature and the level of the work to be performed. It is not intended to include every job duty and responsibility specific to the position. RCM reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.

About the Company

RCM Technologies, Inc. | Life Sciences / Data & Solutions

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