Pharmacy Benefits Verification Specialist

Join to apply for the Pharmacy Benefits Verification Specialist role at Onco360 Oncology Pharmacy

Pharmacy Benefits Verification Specialist Summary

The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate / identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs. They will ensure accurate benefit documentation is made for all prescription orders.

Pharmacy Benefits Verification Specialist Responsibilities

• Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
• Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and / or patients regarding benefit information.
• Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
• Performs full benefits verification on patients for pharmacy benefits and / or medical benefit utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profile.
• Runs test claims at each licensed pharmacy site to obtain a valid claim response and determines optimal reimbursement, then documents outcome of benefits review in CPR+ system to be used by operations and ensures the order is assigned to the appropriate dispensing pharmacy.
• Facilitates process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.
• Maintains a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
• Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
• Conducts job responsibilities in accordance with the standards set out in the company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Pharmacy Benefits Verification Specialist Qualifications

Required : High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification

Required : 1+ years pharmacy or benefit verification experience

Required : Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge / understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand / generic names of medication, basic math and analytical skills, Intermediate typing / keyboarding skills.

Required : Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skill

Benefits

Starting Salary and Incentives

Starting salary at $22 / HR and up. We also offer quarterly incentive bonuses.

Work Hours

Monday-Friday 8am - 5 : 00pm

Seniority Level

Employment Type

Job Function

Industries

Company Overview

Onco360 is a Closed door specialty pharmacy that focuses on patients who are currently undergoing cancer treatment. Our patients are important to us, so we always strive to meet and exceed their needs. We are seeking Pharmacy Benefit Verification Specialists who go above and beyond for our patients, and also passionate about helping others.

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