Pharmacy Care Specialist

2 weeks ago

castle hills, United States Optum Full time
Pharmacy Care Technician Job Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale.

Job Summary

The Pharmacy Care Technician will make outbound calls to members and physicians to improve medication adherence and other pharmacy-related quality metrics. Responsible for gathering prescription refill orders and providing excellent customer service as well as determining the eligibility of members applying for the Medical Assistance Program. May serve as a subject matter expert for the Pharmacy team.

Key Responsibilities
  • Conduct a high volume of outbound calls to members to discuss reasons for non-compliant to medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow-up information from providers.
  • Documents the provider or member's record with accurate information obtained on the call.
  • Performs desk and on-site review of all claims documentation to validate correct billing and that payment made to contracted pharmacies is supported and appropriate.
  • Provides support to internal staff, subcontractors, and providers with respect to Medicare drug-related issues.
  • May serve as a subject matter expert for the Pharmacy team and mentor new employees to the team as necessary.
  • Participates in and contributes to the overall pharmacy quality improvement initiatives.
  • Collects and maintains eligibility information in an appropriate and confidential manner.
  • Enters all assigned applications within a specified time frame in order to ensure eligibility deadlines are met accordingly.
  • Exhibits excellent phone and communication skills while providing complete and accurate information to members.
  • Requests additional or supplemental information via correspondence in order to complete applications.
  • Adheres to assigned schedule and quality metrics.
  • Follows all policy and procedures for the Medical Assistance Program.
Requirements
  • Active and unrestricted Pharmacy Technician license in the state of Texas.
  • National Pharmacy Technician Certification (Certified Pharmacy Technician CPhT).
  • 2+ years of experience in a pharmacy setting.
  • 1+ years of experience with Medicare Part D, particularly the pharmacy record review, claims, billing, and reimbursement rules.
  • 1+ years of experience with HIPAA Privacy and Security Rules and CMS security requirements.
  • 1+ years of experience with Microsoft Office, internet, and e-mail.
  • Intermediate level of writing skills and ability to produce work free from typographical or spelling errors.
  • Advanced knowledge of NCPDP and other types of prescription drug claims.
  • Bilingual (English/Spanish).
What We Offer

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Active and unrestricted Pharmacy Technician license in the state of Texas.

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