Pharmacy Care Coordination Associate

1 week ago


San Antonio, Texas, United States Optum Full time
Company Overview:

Optum is a worldwide entity dedicated to enhancing health outcomes through innovative technology, assisting millions in achieving healthier lifestyles.

The role you will undertake is pivotal in linking individuals with essential healthcare services, pharmacy benefits, and valuable resources.

At Optum, you will be immersed in a culture that values diversity and inclusion, surrounded by skilled colleagues, and presented with extensive benefits and opportunities for professional growth.

Make a significant difference in the communities we serve as you contribute to advancing health equity globally.

Position Summary:

The Pharmacy Care Coordination Associate will be responsible for making outbound communications to members and healthcare providers to enhance medication adherence and other pharmacy-related quality metrics.

Your duties will include:

  • Conducting a high volume of outbound calls to members to address medication non-compliance, schedule pharmacy consultations, and gather essential follow-up information from healthcare providers.
  • Responding to inbound inquiries from members and directing calls to the appropriate departments as needed.
  • Adhering to established scripts while confirming member demographic details.
  • Documenting accurate information in member or provider records based on call interactions.
  • Reviewing claims documentation to ensure correct billing and appropriate payments to pharmacies.
  • Providing assistance to internal teams and providers regarding Medicare-related inquiries.
  • Participating in pharmacy quality improvement initiatives.
  • Maintaining confidentiality while collecting and managing eligibility information.
  • Ensuring timely entry of applications to meet eligibility deadlines.
  • Demonstrating exceptional communication skills while delivering accurate information to members.
  • Requesting additional information through correspondence to complete applications.
  • Following all policies and procedures related to the Medical Assistance Program.
  • Performing other related responsibilities as assigned.
Work Schedule:

Monday to Friday, with rotating weekend shifts.

Qualifications:

Required:

  • High School Diploma or equivalent.
  • Minimum of 1 year of experience in customer service.
  • Experience with Medicare Part D regulations and pharmacy billing.
  • Familiarity with HIPAA regulations.
  • Previous experience in a call center environment.
  • Basic proficiency in Microsoft Office and internet applications.

Preferred:

  • Bilingual candidates are encouraged to apply.
  • Experience in pharmacy benefit management.
  • Knowledge of prescription drug claims processes.
  • Prior retail pharmacy experience.
Why Optum?

Optum offers a competitive salary, comprehensive benefits, and a supportive management team committed to your professional success.

We are dedicated to fostering an inclusive workplace where everyone has the opportunity to thrive.

Optum is an Equal Employment Opportunity / Affirmative Action employer.



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