Medicare Advantage Benefits Technician

🌍 Remote, USA 🎯 Full-time 🕐 Posted Recently

Job Description

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.

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.

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.

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.