Full Time - Direct Placement Title: Health Professional 1-Pharmacy Call Center Representative Compensation: Hourly $11.70 , there is a shift difference on Saturdays of $15.00 and Sundays $25.00 plus benefits. Salary will be commensurate with experience. Availability to work rotating shifts, working seven days a week and holidays. Location: San Juan, PR (On-site) Company Description: Our client is a leading behavioral health organization in Puerto Rico, providing recovery-oriented services to over 1.3 million lives through Medicaid, Medicare, and commercial plans. With a 19-year history and an innovative provider network, we are committed to delivering high-quality care. Position Summary: The Pharmacy Call Center Representative (Health Professional 1) manages telephone inquiries from pharmacies and providers regarding pharmacy benefits, authorization requests, drug use review, and other related matters. This role is crucial in ensuring accurate and timely adjudication of claims. Responsibilities: + Call Management: Efficiently handle inbound calls from pharmacies and providers, providing timely, confidential, and courteous service. + Documentation: Accurately document all calls and drug requests, maintaining comprehensive patient history within electronic records. + Benefit Education: Educate pharmacies about pharmacy benefits, procedures, and related information. + System Authorizations: Process system overrides, including prior authorizations, within the PBM claims processing system to facilitate accurate claim adjudication. + Claims Support: Assist pharmacies with claim processing inquiries and resolve any related issues. + Training Assistance: Contribute to the training of new pharmacy representatives. + Regulatory Compliance: Adhere to all applicable guidelines and regulations set forth by CMS and other relevant agencies. Qualifications: + Technical Proficiency: Strong computer skills, including ability in Microsoft Office Suite and other relevant software. + Customer Service Skills: Excellent interpersonal and communication skills, including active listening and empathy. + Problem-Solving Skills: Ability to analyze problems, find solutions, and take the right action. + Attention to Detail: Meticulous attention to detail to ensure accuracy in all tasks. + Time Management Skills: Effective time management and prioritization skills. + Organizational Skills: Ability to stay organized and manage multiple tasks efficiently. + Clinical Knowledge Application: Apply knowledge of physical and mental pharmacotherapies to accurately assess clinical cases and provide proper support. + Bilingual Proficiency: Fluency in both Spanish and English, both written and spoken. Education: + Minimum 2 years' experience in retail pharmacy preferred. + Pharmacy Technician degree. + Active and unrestricted Pharmacy Technician License in good standing to practice in Puerto Rico. About RCM: RCM is a leading provider of Business, IT, and Engineering Services to over 1,000 clients in the commercial marketplace. RCM partners with clients to define, implement and manage a broad range of technologies across multiple platforms, systems, and networks. Our broad geographic presence ensures that a proven and reliable tactical and strategic capability is available and deployable virtually everywhere in North America. Equal Opportunity Statement: RCM is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Pay Transparency: RCM believes in transparency and fairness in compensation. We are committed to providing our employees with competitive salaries that reflect their skills, experience, and contributions to our organization. As part of our commitment to pay transparency, we want to provide you with as much information as possible about our compensation practices. Disclaimer: This job posting is intended to describe the general nature and the level of the work to be performed. It is not intended to include every job, duty and responsibility specific to the position. RCM reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.