Job DescriptionJob DescriptionPOSITION SUMMARYThe Pharmacy Help Desk Call Center Representative reports to the Pharmacy Help Desk Call Center Supervisor and is responsible to provide a customer service by telephone of incoming and outbound calls to providers, beneficiaries and pharmacies.ESSENTIALS ROLES AND RESPONSIBILITIES1. 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.2. Answer incoming providers’ and beneficiaries’ calls following Call Center scripts, in a timely matter and in accordance with PharmPix call center performance metrics.3. Answer incoming calls and perform outbound calls according to HIPAA and Pharmacy Laws Standards.4. Identify pharmacies, providers and beneficiaries needs, clarify information, research every issue and providing solutions.5. Document all inquiries in the Customer Service Management Applications such as, Service Desk, OneArk and email.6. Route the case to the corresponding internal department or the appropriate Health Insurance Carrier.7. Guide pharmacies, providers and beneficiaries regarding the process of claimtransmission, reimbursement and payment.8. Constantly monitors the BACMAN Alert Application to ensure proper management of rejections at point of sale.9. 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.10. Identify system issues and route to the corresponding internal department.11. Make outbound calls to pharmacies, providers and beneficiaries if necessary.12. Support all Quality Management Program initiatives.13. Perform Special projects and/or other duties assigned by the Operations Manager and or Pharmacy Help Desk Call Center Supervisor.TRAINING & EDUCATIONPharmacy Technician, Technical or Associate DegreeLICENSURE / CERTIFICATIONPuerto Rico Board of Pharmacy Technician Registry Certificate (CPhT), or prospect.PROFESSIONAL EXPERIENCE1 - 2-year customer service or call center experience and healthcare environment (Preferable).PROFESSIONAL COMPETENCIESKnowledge:• Fully Bilingual (Spanish / English written and verbal).• PC skills (Microsoft System)/System oriented.Skills:• 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.Abilities:• Able to effectively interact with internal departments, PharmPix clients, members and other healthcare professionals.• Ability to work with others to reach a solution.• Be able to toggle between several software programs.• Ability to work in a fast-paced environment and multitask. Read More Read Less
Job DescriptionJob DescriptionPOSITION SUMMARY The Financial Analyst reports to the Financial Analysis Manager and is responsible for preparing financial analysis, pricing models, data analysis and reports for the company and monitoring actual results and trends. ESSENTIAL ROLES AND RESPONSIBILITIES Prepare financial analysis and pricing models upon management request.Perform data analysis by collecting and analyzing data & patterns, presenting findings, facilitating informed decision-making and problem resolution. Prepare reports, analysis, and presentations requested by customers and management. Reconciles customer’s actual performance with contract terms and definitions on a monthly, quarterly and/or annual basis. Also, provide responses to submitted findings and perform corrections as necessary.Identifying trends in financial performance and provide recommendations for improvement.Provide support as needed during the monthly accounting closing cycle.Responsible for maintaining Client Side Pricing Tool, including but not limited to: updating contracted pricing, coordinating with IT department to make necessary programming requested by client or management, and perform testing. Coordinate with IT department the creation and validation of different reports required by management to analyze business trends and activities. Maintains technical knowledge by attending educational workshops, reviewing publications (NCPDP). Protect operations by keeping financial information confidential. Contributes to team effort by accomplishing related results as needed. Other tasks and responsibilities as required by Supervisor. TRAINING & EDUCATION BBA major in Finance or Accounting. LICENSURE / CERTIFICATIONCMA or CPA, preferred. PROFESSIONAL EXPERIENCE Five (5) or more years of experience in a combination of financial analysis, reporting and accounting closing cycle. PBM and/or Medicare experience, preferred.
PROFESSIONAL COMPETENCIES Knowledge: Expert Knowledge in MS Office, mainly Excel and Power BI. Basic SQL knowledge, preferred. Fully bilingual English and Spanish. Skills: Strong analytical skills. Great presentation skills. Good oral and written communication skills. Abilities: Excellent time management and organizational ability. Ability to multitask and meet constant deadlines. Adaptability to changing structures and situations. PHYSICAL AND MENTAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear, sit, stand, and walk. The position requires that weight be lifted, and force be exerted up to 25 pounds. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. ENVIRONMENTAL AND WORKING CONDITIONS This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Requires evening or weekend work.
PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans Read More Read Less
