Pharmacy Support Specialist of Medical Management
- United States
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)
The Pharmacy Support Specialist will effectively support the successful implementation and execution of all Medical Management Pharmacy initiatives and processes. The pharmacy support specialist will provide support to Clinical Pharmacists and Nurses to ensure department goals are met. This position will primarily be responsible for conducting outbound calls to patients, pharmacies and provider offices to gather prescription and medical data, assist with troubleshooting member inquiries and providing excellent customer service to all internal and external customers.
- Conducts a high volume of outbound calls to patients to schedule telephonic appointments with clinical pharmacists, and providers to obtain important follow up information
- Collects member's prescription and medical data from multiple computer programs
- Document all patient interactions in a clear, concise and accurate manner in accordance with established procedures
- Assist with triaging returned faxes and sending fax to provider offices
- May answer inbound calls from members or providers and assists them with their inquiries. Routes calls to appropriate department, if necessary
- Follows system scripting and validates member demographic information
- Provides support to internal staff, subcontractors and providers with respect to Medicare drug related issues
- Participates in and contributes to the overall MM pharmacy initiatives
- Exhibits excellent phone and communication skills while providing complete and accurate information to members and provider offices
- Must adhere to assigned schedule and maintain strict confidentiality at all times
- Provides excellent customer service by serving as a resource to all internal and external customers
- Attends required meetings and participates in committees as needed
- Provides clerical and/or administrative support to clinical staff and managers for special studies, projects and reports
- Performs all other related duties as assigned
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.
- Certified Pharmacy Technician (CPhT)
- Minimum of High School Diploma or GED
- Minimum of three years' experience in a pharmacy or medical setting
- Extensive knowledge of the Medicare Part D, particularly the pharmacy record review, claims, billing and reimbursement rules
- Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
- General writing skills and ability to produce work free from typographical or spelling errors.
- Working knowledge of Microsoft Office, Internet and e-mail
- You will be asked to perform this role in an office setting or other company location
- PBM experience
- Previous auditing experience
- Advanced knowledge of NCPDP and other types of prescription drug claims is required
- Working knowledge of Medicare Part B and Part D coverage guidelines and payment methodologies Previous retail pharmacy experience
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Pharmacy Support Specialist, Medical Management Pharmacy, Pharmacy, Medical, Medicare Part D, San Antonio, TX, Texas
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