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3250 Mary Street
Miami, FL 33133
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Part D Coordinator
HealthSun Health Plans • Miami, FL
Posted 18 days ago
Travel - None
Experience - At least 3 year(s)
Degree - High School
Healthcare - Health Services
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HealthSun Health Plans www.healthsun.com is seeking energetic,talented and qualified professionals to join us in our mission of changing the healthcare experience of our members - making it easier, friendlier and more accessible. If you are looking for a challenging and rewarding career with a chance to make a real difference in your community, please apply.
HealthSun Health Plans is headquartered in the Coconut Grove area of Miami, Florida supporting the needs of Medicare Advantage recipients throughout South Florida. We are proud to offer outstanding career advancement opportunities, competitive salaries, paid holidays, medical & dental insurance plans, Paid Time Off, disability benefits, and a 401(k) retirement savings plan.
The Part D Coordinator is responsible for assisting plan members and providers with Part D issues. Works with Part D clinical managers in processing: Exception Requests, Coverage Determinations, Vacation Supplies, Lost Medications and Med Sync. Performs OTC data entry for member’s orders
ESSENTIAL DUTIES & RESPONSIBILITIES
- Act as liaison between pharmacies, medical centers, clinics, Primary Care Physicians, Pharmacy Benefit Management (PBM) and HealthSun Health Plans (HSHP) staff with all member issues.
- Responsible for entering daily coverage determinations, vacation supplies and lost medications requests.
- Daily, enter all received OTC medication orders.
- Ensure accuracy of all documentation related to position.
- Assist members with issues such as: OTC resolution, medication delivery status and related questions.
- Become proficient with CMS guidelines pertaining to Part D related topics.
- Maintain electronic records as per CMS guidelines.
- Communicates effectively with other professional and support staff in order to achieve positive customer outcomes.
- Promotes and contributes to a positive, problem-solving environment.
- Assists members, family members and others with concern and empathy; respect their confidentiality and privacy and communicate with them in a courteous and respectful manner.
- Complies with company policies and procedures and maintains confidentiality of records in accordance with state and federal laws.
- Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations.
- Participates in meetings, training and in-service education, as required.
- Performs other duties as assigned.
QUALIFICATIONS & EDUCATION
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Minimum of a High School diploma or equivalent
- Must be registered and in good standing with the Florida Department of Health (Board of Pharmacy) with a minimum of 1-3 years’ experience
- Certified Pharmacy Technician (PTCB) preferred
- Preferred experienced from Medicaid or Medicare Plans
- Strong interpersonal skills
- Excellent computer knowledge is required, including proficient knowledge of Microsoft Office
- Must be patient in dealing with an elderly population and sympathetic to hearing or vision deficiencies
- Excellent listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization
- Ability to work effectively independently and in a team environment
- Ability to read, analyze, and interpret technical procedures or governmental regulations
- Ability to write reports, business correspondence, and procedure manuals
- Ability to effectively present information and respond to questions from groups of managers, members and general public
- Ability to calculate figures and amounts, such as discounts, interest, commissions, proportions, percentages, area and volume
- Ability to define problems, collect data, establish facts, and draw valid conclusions
- Strong decision-making, analytical skills
- Must be self-motivated, organized and have excellent prioritization skills
- Must be able to work well under stressful conditions
- Must be able to work in a fast paced environment
- Fluency in Spanish and English required.
HealthSun Health Plans and its affiliated companies is an equal opportunity/affirmative action employer and complies with all federal and state laws, regulations and executive orders regarding affirmative action requirements in all programs.M/F/D/V.
HealthSun and its affiliates are also a drug-free workplace.
*Internal candidates must submit the Internal Application Form approved by his/her supervisor before interviewing with HR. Qualified candidates will be considered by the Hiring Manager.
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