If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

This position will be 8 hour shifts between the hours of 8am-8pm (schedule to be determined).

PRIMARY RESPONSIBILITIES:

• Manage inbound and outbound calls to/from members to discuss medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow up information from providers
• Perform desk and on-site review of all claims documentation to validate correct billing
• Provide support to internal staff, subcontractors and providers with respect to Medicare drug related issues
• May serve as a subject matter expert for the Pharmacy team and mentor new employees to the team as necessary
• Participate in and contribute to the overall pharmacy quality improvement initiatives
• Collect and maintain eligibility information in an appropriate and confidential manner
• Enter all assigned applications within a specified time frame in order to ensure eligibility deadlines are met accordingly
• Exhibit excellent phone and communication skills while providing complete and accurate information to members
• Request additional or supplemental information via correspondence in order to complete applications
• Adhere to assigned schedule and quality metrics
• Follow all policy and procedures for the Medical Assistance Program
• Perform all other related duties as assigned

REQUIRED QUALIFICATIONS:

• Certified Pharmacy Technician (CPhT)
• High School Diploma or GED
• 2+ years of experience in a pharmacy setting with an additional 1 year of experience in a customer service setting

PREFERRED QUALIFICATIONS:

• Extensive knowledge of the Medicare Part D, particularly the pharmacy record review, claims, billing and reimbursement rules
• Bilingual
• PBM experience
• Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
• Previous auditing experience
• 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 Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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: 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.

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.