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Pharmacy Care Specialist
2 months ago
Job Summary:
The Associate Pharmacy Care Specialist will play a critical role in improving medication adherence and quality metrics for Optum's members. This position will involve making outbound calls to members and physicians to discuss reasons for non-compliance with medication(s), schedule pharmacy telephonic appointments, and obtain important follow-up information from providers.
Key Responsibilities:
- Conduct a high volume of outbound calls to members to discuss reasons for non-compliance with medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow-up information from providers.
- Document the provider or member's record with accurate information obtained on the call.
- Perform desk and on-site review of all claims documentation to validate correct billing and that payment made to contracted pharmacies is supported and appropriate.
- Provide support to internal staff, subcontractors, and providers with respect to Medicare drug-related issues.
- Participate in and contribute to the overall pharmacy quality improvement initiatives.
- Collect and maintain eligibility information in an appropriate and confidential manner.
- Enter all assigned applications within a specified time frame to ensure eligibility deadlines are met accordingly.
- Exhibit excellent phone and communication skills while providing complete and accurate information to members.
- Request additional or supplemental information via correspondence in order to complete applications.
- Adhere to assigned schedule and quality metrics.
- Follow all policy and procedures for the Medical Assistance Program.
- Ability to use fine motor skills to operate office equipment and/or machinery.
- Ability to receive and comprehend instructions verbally and/or in writing.
Requirements:
- Active and unrestricted Pharmacy Technician license in the state of Texas.
- National Pharmacy Technician Certification (Certified Pharmacy Technician CPhT).
- 1+ years of experience in a pharmacy setting.
- Basic level of proficiency with Medicare Part D, particularly the pharmacy record review, claims, billing, and reimbursement rules.
- Basic level of proficiency with HIPAA Privacy and Security Rules and CMS security requirements.
- Basic level of proficiency with writing skills and ability to produce work free from typographical or spelling errors.
- Basic level of proficiency with Microsoft Office, Internet, and e-mail, including the ability to produce work free from typos.
- Bilingual (any language).
- Advanced knowledge of NCPDP and other types of prescription drug claims is required.
- Knowledge of Medicare Part B and Part D coverage guidelines and payment methodologies.
