Pharmacy Support Specialist - WellMed - San Antonio, TX - Full-time / Part-time

You're looking for something bigger for your career. How about inventing the future of health care? OptumRx is creating an innovative approach to Pharmacy Benefit Management. Here you'll find a professional culture where you can use your talent and our resources to make an impact on a huge scale. With better schedules than retail and more reach than any hospital, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Take this opportunity to start doing your life's best work. (SM)

The Pharmacy Eligibility Specialist is responsible for determining the eligibility of patients applying for the Medical Assistance Program (MAP).  The Pharmacy Support Specialist will review pharmacy claims from the contracted pharmacies to determine billing and payment accuracy. The position also interfaces with a population of patients that are Medicare eligible; primarily works on a multi-line telephonic system and handle customer service issues as deemed necessary by business needs. 

Primary Responsibilities:

• Initiates the process of granting, modifying, denying, or terminating assistance, or referring applicants to other agencies for assistance


• Collects and maintains eligibility information in an appropriate and confidential manner


• Interviews applicants by phone for program requirements


• Enters all assigned applications within a specified time frame in order to ensure eligibility deadlines are met accordingly


• 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


• Presents the audit results including identified deficiencies & corrective recommendations to management for decision making


• Exhibits excellent phone and communication skills while providing complete and accurate information to customers


• 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


• Maintains abreast of program qualifications in order to troubleshoot problems that may arise during the eligibility process


• Follows all policy and procedures for the Medical Assistance Program


• Performs all other related duties as assigned

Required Qualifications:

• High School Diploma or GED


• Certified Pharmacy Technician (CPhT)


• 1+ years experience as a pharmacy technician


• 1+ years of experience in a customer service environment


• 1+ year working knowledge of Medicare Part D rules


• Must have excellent verbal communication skills and customer service skills


• Working knowledge of Microsoft Office applications


• Ability to lift up to 10 pounds


• Ability to push or pull heavy objects using up to 25 pounds of force


• Ability to sit for extended periods of time


• Ability to stand for extended periods of time


• Ability to use fine motor skills to operate office equipment and/or machinery


• Ability to properly drive and operate a company vehicle


• Ability to receive and comprehend instructions verbally and/or in writing


• Ability to use logical reasoning for simple and complex problem solving

Preferred Qualifications:

• Bilingual (English/Spanish)


• 1+ years of experience in a healthcare, customer service environment 


• 1+ years of experience as an eligibility specialist or comparable work


• Proficiency with Microsoft Office applications

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)

Diversity creates a healthier atmosphere: 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, Pharmacy Tech, San Antonio, TX