Pharmacy Support Specialist

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.  

The Pharmacy Support Specialist 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. May serve as a subject matter expert for the Pharmacy team.

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
• May serve as a subject matter expert for the Pharmacy team and mentor new employees to the team as necessar
• 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

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 or GED
• Certified Pharmacy Technician (CPhT)
  
• 2+ years of experience in a pharmacy setting with an additional 1+ years of experience in a customer service 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
• Working knowledge of Microsoft Office, Internet and e-mail
• Advanced knowledge of NCPDP and other types of prescription drug claims
• Proven general writing skills and ability to produce work free from typographical or spelling errors
• Ability to work at least one Saturday per month

Preferred Qualifications:

• PBM experience
• Call Center experience
• Retail pharmacy experience
  
• Working knowledge of Medicare Part B and Part D coverage guidelines and payment methodologies
• Bilingual

Physical & Mental Requirements:

• Ability to push or pull heavy objects using up to pounds of force
• Ability to stand for extended periods of time
• Ability to properly drive and operate a company vehicle

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.