Pharmacy Help Desk Call Center Representative
About The Position
The Pharmacy Help Desk Call Center Representative reports to the Pharmacy Help Desk Call Center Supervisor and is responsible to provide customer service by telephone for incoming and outbound calls to providers, beneficiaries, and pharmacies. This role involves handling issues related to claim transactions, reimbursement, payment, and other required information, while adhering to performance metrics and maintaining compliance with HIPAA and Pharmacy Laws Standards. The representative will identify needs, clarify information, research issues, provide solutions, and document all interactions in customer service management applications. They will also route cases to appropriate departments, guide users on claim processes, monitor specific applications for rejection management, evaluate criteria for coverage determinations, and identify system issues.
Requirements
- 1 - 2-year customer service or call center experience
- Experience in a healthcare environment (Preferable).
- Fully Bilingual (Spanish / English written and verbal).
- PC skills (Microsoft System)/System oriented.
- Strong customer service skills.
- Excellent phone, written, active listening and follow-through skills.
- Skill in analyzing situations accurately and taking effective action.
- Attention to details.
- 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.
- Able to effectively interact with internal departments, PharmPix clients, members and other healthcare professionals.
- Ability to work in a fast-paced environment and multitask.
Nice To Haves
- Experience in a healthcare environment
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.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
