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Pharmacy Care Coordinator
2 months ago
As a Pharmacy Care Coordinator at Optum, you will play a critical role in improving health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best.
Key Responsibilities- Conduct high-volume outbound calls to members to discuss reasons for non-compliant medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow-up information from providers.
- May answer inbound calls from members and assist them with their inquiries, routing calls to the appropriate department if necessary.
- Follow system scripting and validate member demographic information.
- 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 ensure 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.
- Exhibit excellent phone and communication skills while providing complete and accurate information to members.
- Request additional or supplemental information via correspondence to complete applications.
- Adhere to assigned schedule and quality metrics.
- Use a multi-lined telephonic system to answer calls regarding eligibility requirements and medication refill orders.
- Follow all policy and procedures for the Medical Assistance Program.
- High School Diploma/GED (or higher)
- 1+ years of experience in a customer service setting
- 6+ months of previous experience with Medicare Part D, particularly the pharmacy record review, claims, billing, and reimbursement rules
- 6+ months of previous experience with HIPAA Privacy and Security Rules and CMS security requirements
- 6+ months of previous call center experience
- Basic level of proficiency with Microsoft Office, Internet, and e-mail, including the ability to produce work free from typographical or spelling errors
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Bilingual (English/Spanish)
- PBM experience
- Advanced knowledge of NCPDP and other types of prescription drug claims
- Working knowledge of Medicare Part B and Part D coverage guidelines and payment methodologies
- Previous retail pharmacy experience
