The WellMed Quality Pharmacy Operations team supports WellMed Medical Management by delivering patient-centered, clinically collaborative medication consultations to help people live healthier lives. Our team focuses on the design, execution, and delivery of telephonic and digital engagement strategies designed to close STARs measure gaps in care, e.g. medication adherence, care for older adults, statins in patients with diabetes. Our interdisciplinary service delivery team is comprised of Pharmacists, Pharmacy Technicians, Licensed Vocational Nurses, and Care Coordinators.
$1000 Sign On Bonus for external candidates looking to join a growing pharmacy team!
The Pharmacy Technician will perform telephonic, patient-centered engagements for a variety of member-facing campaigns. In addition, the PT will assist in pre- and post-engagement documentation for the pharmacy team. The pharmacy technician will be required to meet or exceed established productivity and quality metrics and work a flexible schedule to support the hours of operation of the business (Mon-Fri 8am-8pm Central and Saturday 8am-5:30pm Central).
Conduct a high volume of outbound calls to members to discuss reasons for non-compliance 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. Uses a multi-lined telephonic system to answer calls regarding eligibility requirements and medication refill orders.
May answer inbound calls from members and assists them with their inquiries. Routes calls to appropriate department if necessary.
Documents the provider or member's record with accurate information obtained on the call to meet quality control guidelines.
Provide information to qualified members about plan services and potential benefits and direct them via warm transfer to appropriate resources.
Obtain information and perform data entry of reconciled medication lists, allergy history, vaccine history, medical conditions and other pertinent member-related information adhering to HIPAA Guidelines.
Participates in and contributes to the overall pharmacy quality improvement initiatives.
Exhibits excellent phone and communication skills while providing complete and accurate information to members.
Maintain performance standards including weekly /monthly call goals by entering all assigned applications within a specified time frame in order to ensure eligibility deadlines are met.
Adheres to assigned schedule and quality metrics.
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.
High School Diploma or GED
Certified Pharmacy Technician (CPhT)
2+ years of experience practicing with a license and at least one-year 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
General writing skills and ability to produce work free from typographical or spelling errors.
Working knowledge of Microsoft Office, Internet and e-mail
Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
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
Previous Call Center 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)
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.
Job Keywords: Pharmacy Technician, Pharm Tech, call center, intake, prior authorization, medical assistant, administrative medicine, clerical, claims, San Antonio, TX, Texas, WellMed, Optum, UHG, RX