Pharmacy Call Center Specialist

5 days ago

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Abarca Health

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Pharmacy Benefit Management (PBM) • Health Business Intelligence • Health Information Technology (HIT) • Medicare • Medicaid

501 - 1000

Description

• Manage all incoming calls, emails, faxes and web-generated requests from pharmacies, beneficiaries, and prescribers. • Provide service-level standards set by CMS or by client; 80% of calls should fall within service level, less than 5% abandon rate and speed to answer should be less than 30 seconds. • Rejection support, including overrides. • Provide Coverage Determination status to clients including exceptions and appeals. • Administrative PAs- Document PA request inquiries, issues, status, and resolution in accordance with federal and department and company policies and guidelines. • Answer questions and recommend corrective services to address customer complaints, payment status, manual reversal requests, benefit and eligibility support, provider portal support and response to price appeals. • Report identified issues to the appropriate department, for investigation and correction, following the established procedure.

Requirements

• Associate’s Degree in Pharmacy Technician (in lieu of a degree, equivalent, relevant work experience may be considered.) • 1+ years of experience working in a Pharmacy or Member Services Call Center, Retail or Hospital Pharmacy Setting. • Excellent oral and written communication skills. Bilingual fluency in Spanish and English is required. • We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only). • This position requires availability to work in a specified time zone, accommodating the business needs of our clients and team members based in the in the determined time zone. • This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).