Pharmacy Care Coordinator

6 hours ago


Converse, Texas, United States Optum Full time
Optum Pharmacy Care Coordinator Job Description

At Optum, we're dedicated to helping people live healthier lives and making the health system work better for everyone. As a Pharmacy Care Coordinator, you'll play a critical role in improving medication adherence and quality metrics for our members.

Key Responsibilities:

  • Conduct outbound calls to members to discuss medication adherence and schedule pharmacy appointments
  • Answer inbound calls from members and assist with inquiries
  • Follow system scripting and validate member demographic information
  • Document provider or member records with accurate information
  • Perform desk and on-site review of claims documentation to ensure correct billing and payment
  • Provide support to internal staff and providers with Medicare drug-related issues
  • Participate in pharmacy quality improvement initiatives
  • Collect and maintain eligibility information in a confidential manner
  • Enter applications within specified time frames to meet eligibility deadlines

What We Offer:

  • Competitive base pay
  • Comprehensive benefits package
  • Performance rewards
  • Opportunities for career growth and development

Requirements:

  • High school diploma or equivalent
  • 1+ years of customer service experience
  • 6+ months of experience with Medicare Part D, pharmacy record review, claims, billing, and reimbursement rules
  • 6+ months of experience with HIPAA Privacy and Security Rules and CMS security requirements
  • 6+ months of call center experience
  • Basic proficiency with Microsoft Office, Internet, and email

Preferred Qualifications:

  • Bilingual (English/Spanish)
  • PBM experience
  • Advanced knowledge of NCPDP and prescription drug claims
  • Working knowledge of Medicare Part B and Part D coverage guidelines and payment methodologies

Why Work for Optum?

At Optum, we're committed to making a positive impact on the communities we serve. We believe in the importance of diversity, equity, and inclusion, and we're dedicated to creating a workplace that reflects these values. If you're passionate about healthcare and making a difference in people's lives, we encourage you to apply for this exciting opportunity.



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