Medicare Advantage Benefits Technician
Location: Pearland Administrative Office
Department: Pharmacy Services
Job Type: Full Time
Kelsey-Seybold Clinic. Your Doctors for Life.
Since 1949, Kelsey-Seybold Clinic has served its patients with one goal in mind – combine the expertise of physicians in a variety of medical specialties, with the close personal care of a family doctor. Kelsey-Seybold is Houston’s largest community-based physician group, caring for more than 400,000 patients. With 21 clinic locations, we are growing to meet the health care needs of our diverse patient population. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.
This position is 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. This position also includes, 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. This position may conduct outbound calls regarding patient adherence to medications and assist patients to refill medications in a prompt and courteous manner utilizing a PC. This position is also 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. This position confirms appointments and handles cancellations in a timely, efficient and courteous manner. The employee in this position should be able to provide comprehensive service in order to facilitate a resolution to caller requests and triage calls to the appropriate team members when necessary. The employee should 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.
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
A. High School Diploma or GED
B. 30 hours of college credit from an accredited college or university
A. 6 months operational pharmacy benefit experience B. 2 years Medicare Part D experience
A. 6 months operational pharmacy benefit experience OR 6 months experience in a high volume call center OR 6 months of customer service experience OR 6 months retail pharmacy experience
B. 2 years Medicare Part D experience
2 years high volume call center experience
A. TSBP Registered Pharmacy Technician
B. 2 years HMO 3rd party managed care experience
A. Good Alpha/Numeric data entry skills with minimal errors
Excellent customer service, telephone etiquette skills, and active listening skills
Proficient 2 with computer applications that including, but not limited to: Microsoft Word, Excel, and Access
Demonstrates strong problem solving and analytical skills
Type 20 WPM. 10 key by touch
B. Auditing experience
Ability to exercise good judgment during high call volume while maintaining a professional attitude
A. Communication skills, professional appearance, and ability to work effectively in a fast paced work environment.
Ability to speak, write and understand the English language
Detail oriented with excellent verbal and written communication skills
B. Bilingual English/Spanish