- Prepare monthly team schedules while taking into consideration call volumes, peak hours, personnel availability, and seasonal events.
- Monitor Rx Customer teams' timeliness and attendance, ensuring specialists are complying with their scheduled hours and that all information entered within payroll systems (UKG and ADP) is accurate.
- Monitor incoming calls and back-office duties for purposes related to quality, compliance, and employee development.
- Coordinate training and development courses on both a team and one-on-one basis as needed.
- Assist Rx Customer Service Specialists in managing all incoming calls, emails, faxes, and web-generated requests from pharmacies, beneficiaries and prescribers including but not limited to coverage determination, exception and appeal status and rejection support including overrides.
- Real-time, daily, and monthly monitoring of call center performance metrics to ensure proper adjustments are made in a timely manner and that all calls are managed within the service-level standards set by Center for Medicare and Medicaid Services (CMS) and our clients.
- Document administrative prior authorization (PA) request inquiries, issues, status, and resolution in accordance with federal and department / company policies and guidelines.
- Answers questions and recommends corrective actions to address customer complaints, payment status, manual reversal requests, benefit/eligibility support, provider portal support and responses to price appeals.
- Assists with member card production, provider directories and conduct client satisfaction survey
- Associate's Degree as a Pharmacy Technician. (In lieu of a degree, equivalent relevant work experience may be considered).
- 5+ years of experience working in pharmacy or healthcare call center areas.
- 5+ years or more of experience as a team leader or supervisor.
- Skilled in areas such as analytical and critical thinking, attention to detail, organizational skills and superior interpersonal as well as customer service skills.
- Excellent communications skills both written and oral. Bilingual Fluency in English and Spanish is required.
- Prior experience in insurance, pharmacy, and/or healthcare is a plus.
- Current/Active Certified Pharmacy Technician License is a plus.
- Knowledge of pharmacy benefit management (PBM) clinical operations and Medicare Part D is a plus.
- Analytical
- Motivator
- Detailed
- Problem solver
- Leader / Mentor
- Must be able to access and navigate each department at the organization's facilities.
- Sedentary work that primarily involves sitting/standing.
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Team Leader - San Juan, Puerto Rico - abarca health
Descripción
What you'll do
In a few words...
Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning...
Abarca's Service Operations team takes the charge by handling two areas of detail-oriented and quality care: Clinical Outreach and Services. From maintain the health of our beneficiaries through case management and Medication Therapy Management Programs (MTM) to addressing eligibility requests or price appeal considerations, this team goes above and beyond to ensure the client and beneficiary are satisfied They assist in major areas such as Coverage Determination that cover cases prior to adjudication, and triaging calls from physicians and pharmacies; Rx Customer Service for conducting satisfaction surveys, addressing complaints, managing manual reversal requests; Clinical Outreach for case management and beneficiary lifestyle care as well as MTM program management; and lastly, Clinical Services for our myriad of clinical programs (MTMP, HCIP, Hepatitis, etc.) and collaboration with our pharmacists as well as pharmacy consultants. We are looking to add a Team leader for our Rx Customer Service team.
As a Team Leader Pharmacy Call Center you will lead a dedicated team through beneficiary, client, physician, and pharmacy support. You will have oversight on areas such as scheduling hours, training, reviewing service level metrics and KPIs as well as quality monitoring. Also, you will assist the Rx Customer Service Specialists not just with escalations but also with any incoming and outgoing communications with pharmacies, beneficiaries, and prescribers. Abarca's proprietary platforms will be open for your use; especially one of Darwin's many modules, Rx Platform, which will aid in resolving callers needs.
The fundamentals for the job...
What you're made of
The bold requirements...
Nice to Have...
That something extra we ́d love to see...
Physical requirements...
