Position Summary:

The Health Professional 1-Pharmacy Call Center Representative manages telephone calls from pharmacies and providers related to pharmacy benefits, authorization requests, drug use review, among others, to ensure that claims are correctly and timely adjudicated.

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

8. 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.