Company Overview
Our client is a leading group in the provision of mental health services in Puerto Rico, providing services in practices in the health industry, such as telemedicine and home services.
Job Summary
The Pharmacy Call Center Representative manages telephone calls and Prior Authorizations from pharmacies and providers related to pharmacy benefits, authorization requests, and drug use reviews, among others, to ensure that claims are correctly and timely adjudicated.
Responsibilities
- Answers and manages telephone calls from pharmacies and providers in a timely, confidential, and courteous manner.
- Documents calls and/or drug requests with complete follow-up history of the patient through electronic records.
- Provides orientation to pharmacies regarding pharmacy benefits.
- Performs system overrides (e.g., prior authorization) on the PBM claims processing system to ensure that claims are correctly adjudicated.
- Assists pharmacy’s claim processing.
- Assist in the training of pharmacy representatives.
- Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
- In addition, all other duties are assigned by the manager and/or supervisor.
Requirements
- Pharmacy Technician Course at an accredited school.
- Possess an active professional unrestricted Pharmacy Technician License in good standing to practice in Puerto Rico territory.
- Availability to work rotating shifts Monday to Sunday 7:00am to 10:00pm.
- Availability for hybrid work.
EEO
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