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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization 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, 9:00 AM – 6:00 PM and Saturday rotation (8:00 AM – 5:00 PM)
Location: Onsite - 19500 W Interstate 10, San Antonio, TX 78257
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 auto dialer 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 the 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
- Collect and maintains eligibility information in an appropriate and confidential manner
- Enters all assigned applications within a specified time frame 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 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
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
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 experience with Medicare Part D, particularly the pharmacy record review, claims, billing and reimbursement rules
- 6+ months of experience with HIPAA Privacy and Security Rules and CMS security requirements
- Beginner level of proficiency with Microsoft Office, Internet and e-mail including the ability 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:
- PBM experience
- Previous Call Center experience
- Advanced level of 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
- Bilingual (English/Spanish)
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 to $27.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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