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. Join us to start Caring. Connecting. Growing together.
The Associate Pharmacy Care Coordinator 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.
Schedule: Monday to Friday 9:00am to 6:00pm CST with rotating Saturdays from 8:00am to 5:00pm CST
Primary 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. Outbound calls are made primarily using an autodialer requiring precision to detail and adaptability to type of response needed
- May answer inbound calls from members and assists them with their inquiries. Routes calls to appropriate department if necessary
- Follows system scripting and validates member demographic information
- 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
- 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
- Uses a multi-lined telephonic system to answer calls regarding eligibility requirements and medication refill orders
- Follows all policy and procedures for the Medical Assistance Program
- Performs all other related duties as assigned
- Receives and comprehends instructions verbally and/or in writing
- Uses logical reasoning for simple and complex problem solving
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- More information can be downloaded at: style="font-family: Tahoma, sans-serif;">
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.
Required Qualifications:
- 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 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
Preferred Qualifications:
- 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
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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