Medicare Advantage Benefits Technician
About the position
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.
Responsibilities
• Assist the Pharmacy Health Plan Services area in the management of the Medicare Advantage Part D prescription benefits.
• Triage and/or resolve pharmacy services phone calls, audits, and monitoring functions to ensure prescription benefits are administered cost effectively, timely, accurately, and in compliance with CMS standards.
• Process coverage determinations per Medicare Part D program regulations.
• Assist the Health Plan Pharmacy Services department with the management of Kelsey-Seybold Clinics' Pharmacy Quality Initiatives (i.e. MTMP, Hospital Discharge, RXQI, and Adherence).
• Schedule appointments and monitor functions to ensure Pharmacy Initiatives are administered efficiently and accurately.
• Conduct outbound calls regarding patient adherence to medications and assist patients to refill medications in a prompt and courteous manner.
• Perform general clerical duties including member mailings, verifying addresses for return mail, data entry, processing collection letters, and documenting member outcomes.
• Confirm appointments and handle cancellations in a timely, efficient, and courteous manner.
• Provide comprehensive service to facilitate resolution to caller requests and triage calls to appropriate team members when necessary.
• Acquire and maintain computer skills to effectively utilize software and Windows based programs.
Requirements
• High School diploma or GED from an accredited program.
• TSBP Registered Pharmacy Technician.
• 6+ months of operational pharmacy benefit experience OR 6+ months of experience in a high volume call center OR 6+ months of customer service experience OR 6+ months of retail pharmacy experience.
• Good Alpha/Numeric data entry skills with minimal errors.
• Excellent customer service, telephone etiquette skills, and active listening skills.
• Proficient with computer applications including Microsoft Word, Excel, and Access.
• Demonstrated solid problem solving and analytical skills.
• Ability to Type 20 WPM. 10 key by touch.
Nice-to-haves
• Some college or technical school.
• 2+ years of Medicare Part D experience.
• 2+ years of high volume call center experience.
• 2+ years of HMO 3rd party managed care experience.
• Auditing experience.
• Ability to exercise good judgment during high call volume while maintaining a professional attitude.
• Bilingual English/Spanish.
Benefits
• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution.
Apply Now
Apply Now
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.
Responsibilities
• Assist the Pharmacy Health Plan Services area in the management of the Medicare Advantage Part D prescription benefits.
• Triage and/or resolve pharmacy services phone calls, audits, and monitoring functions to ensure prescription benefits are administered cost effectively, timely, accurately, and in compliance with CMS standards.
• Process coverage determinations per Medicare Part D program regulations.
• Assist the Health Plan Pharmacy Services department with the management of Kelsey-Seybold Clinics' Pharmacy Quality Initiatives (i.e. MTMP, Hospital Discharge, RXQI, and Adherence).
• Schedule appointments and monitor functions to ensure Pharmacy Initiatives are administered efficiently and accurately.
• Conduct outbound calls regarding patient adherence to medications and assist patients to refill medications in a prompt and courteous manner.
• Perform general clerical duties including member mailings, verifying addresses for return mail, data entry, processing collection letters, and documenting member outcomes.
• Confirm appointments and handle cancellations in a timely, efficient, and courteous manner.
• Provide comprehensive service to facilitate resolution to caller requests and triage calls to appropriate team members when necessary.
• Acquire and maintain computer skills to effectively utilize software and Windows based programs.
Requirements
• High School diploma or GED from an accredited program.
• TSBP Registered Pharmacy Technician.
• 6+ months of operational pharmacy benefit experience OR 6+ months of experience in a high volume call center OR 6+ months of customer service experience OR 6+ months of retail pharmacy experience.
• Good Alpha/Numeric data entry skills with minimal errors.
• Excellent customer service, telephone etiquette skills, and active listening skills.
• Proficient with computer applications including Microsoft Word, Excel, and Access.
• Demonstrated solid problem solving and analytical skills.
• Ability to Type 20 WPM. 10 key by touch.
Nice-to-haves
• Some college or technical school.
• 2+ years of Medicare Part D experience.
• 2+ years of high volume call center experience.
• 2+ years of HMO 3rd party managed care experience.
• Auditing experience.
• Ability to exercise good judgment during high call volume while maintaining a professional attitude.
• Bilingual English/Spanish.
Benefits
• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution.
Apply Now
Apply Now