Medicare Advantage Benefits Technician

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.

Primary Responsibilities:

• Responsible for assisting the Pharmacy Health Plan Services area in the management of the Medicare Advantage Part D prescription benefits
• Under the supervision of the Health Plan Pharmacy Manager and/or Supervisor, this position is primarily responsible for triaging and/or resolving pharmacy services phone calls, audits and monitoring functions that help ensure prescription benefits are administered cost effectively, timely, accurately and in compliance with CMS standards
• Processing coverage determinations per Medicare Part D program regulations and assisting the Health Plan Pharmacy Services department with the management of Kelsey-Seybold Clinics' Pharmacy Quality Initiatives (i.e. MTMP, Hospital Discharge, RXQI, and Adherence)
• Additional activities may include scheduling appointments and monitoring functions that help ensure Pharmacy Initiatives are administered efficiently, accurately and in compliance with the departments' standard operating procedures
• May conduct outbound calls regarding patient adherence to medications and assist patients to refill medications in a prompt and courteous manner utilizing a PC
• Responsible for general clerical duties which include but are not limited to member mailings, verifying addresses for return mail, data entry, processing collection letters and documenting member outcomes
• Confirms appointments and handles cancellations in a timely, efficient and courteous manner
• Provide comprehensive service in order to facilitate a resolution to caller requests and triage calls to the appropriate team members when necessary
• Acquire and maintain computer skills to effectively utilize software and Windows based programs as well as be able to quickly learn processes and put into practice learned principles

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 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 that including, but not limited to: Microsoft Word, Excel, and Access
• Demonstrated solid problem solving and analytical skills
• Ability to Type 20 WPM. 10 key by touch

Preferred Qualifications:

• 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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 to $27.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.