Large managed care company looking to fill a contract position lasting through May 16, 2020.

Description:

Current and active Pharmacy Technicians Certification Board License (PTCB)

Job Summary

The Pharmacy Support Specialist will make outbound calls to members and physicians to improve medication adherence and other pharmacy related quality metrics. Responsible for gathering prescription refill orders and providing excellent customer service as well as determining the eligibility of members applying for the Medical Assistance Program.

Essential Job Functions
1. Conduct a high volume of outbound calls to members to discuss reasons for non-compliant to medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow up information from providers. Outbound calls are made primarily using an autodialer requiring precision to detail and adaptability to type of response needed.
2. May answer inbound calls from members and assists them with their inquiries. Routes calls to appropriate department if necessary.
3. Follows system scripting and validates member demographic information.
4. Documents the provider or member's record with accurate information obtained on the call.
5. 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.
6. Provides support to internal staff, subcontractors and providers with respect to Medicare drug related issues.
7. Participates in and contributes to the overall pharmacy quality improvement initiatives.
8. Collects and maintains eligibility information in an appropriate and confidential manner.
9. Enters all assigned applications within a specified time frame in order to ensure eligibility deadlines are met accordingly.
10. Exhibits excellent phone and communication skills while providing complete and accurate information to members.
11. Requests additional or supplemental information via correspondence in order to complete applications.
12. Adheres to assigned schedule and quality metrics.
13. Uses a multi-lined telephonic system to answer calls regarding eligibility requirements and medication refill orders.
14. Follows all policy and procedures for the Medical Assistance Program
15. Performs all other related duties as assigned.



Minimum Required Education, Experience & Skills
? Certified Pharmacy Technician (CPhT)
? Minimum of High School Diploma or GED
? Minimum of two years’ experience in a pharmacy setting
? Extensive knowledge of the Medicare Part D, particularly the pharmacy record review, claims, billing and reimbursement rules
? Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
? General writing skills and ability to produce work free from typographical or spelling errors.
? Working knowledge of Microsoft Office, Internet and e-mail

Preferred Education, Experience & Skills
? Bilingual
? PBM experience
? 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

Work Address:
6000 NORTHWEST PARKWAY 
San Antonio, Texas 78249

Hours: 9am- 6pm- M-F