Medical Benefits Verification Specialist

Onco360, Inc.; Town of Hyde Park (NY); On-site; Full time

Job summary

Onco360 is seeking a Medical Benefits Verification Specialist to ensure accurate patient insurance documentation. The role involves verifying government and commercial insurance eligibility and benefits, contributing to the patient care process. This entry-level position provides opportunities for professional growth and offers comprehensive benefits including medical, dental, and paid time off.

Benefits

Medical, Dental & Vision insurance

401k with a match

Paid Time Off and Paid Holidays

Tuition Reimbursement

Paid Volunteer Day

Floating Holiday

Referral Incentive

Paid Life and Disability insurance

Qualifications

• 1+ years of Medicare and Medical benefit verification experience required.
• Knowledge of Medicare Parts A, B, C, and D.
• Basic math and typing skills needed.

Responsibilities

• Verify Medicare and Medicaid eligibility and benefits.
• Communicate with physicians and insurance companies.
• Ensure accurate patient setup in CPR+ system.

Skills

Medicare insurance verification

Medical benefit verification

Knowledge of pharmacy terminology

Analytical skills

Interpersonal skills

Education

High School Diploma or GED

Associate degree

Job description

Medical Benefits Verification Specialist

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

Medical Benefits Verification Specialist

5 days ago Be among the first 25 applicants

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

Are you someone looking for professional career growth? Onco360 Pharmacy is looking for a Medical Benefits Verification Specialist for our Pharmacy located in New Hyde Park, NY.

Work Hours: Monday-Friday 9am - 6:00pm EST

• Starting salary at $25/hr** We also offer quarterly incentive bonuses.
  
  

We offer a variety of benefits including:

• Medical, Dental & Vision insurance
• 401k with a match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Paid Volunteer Day
• Floating Holiday
• Referral Incentive
• Paid Life, and short & long-term disability insurance
  
  

Medical Benefits Verification Specialist Summary:

The Medical Benefit Verification Specialist will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and investigate/identify authorization requirements needed to obtain medication coverage. They will ensure accurate insurance benefit documentation is made for specific IV and oral therapy orders.

Medical Benefits Verification Specialist Major Responsibilities:

• Verify Government payer (i.e. Medicare and Medicaid) eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contacting Medicare or other relevant government payers to confirm coverage and benefits for specific services.
• Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. Confirming patient eligibility and benefits with various commercial insurance carriers (i.e. Aetna, Humana, Anthem, Cigna, etc.).
• Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information and patient copays, deductibles and Out-of-Network responsibilities.
• Determine optimal reimbursement based on medical plan and dispensing location, then document outcome of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy.
• Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.
• Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information, doctors’ notes, assessments and lab reports.
• Communicate succinctly and professionally both verbally and through written correspondence with Physician offices, nurses, insurance companies and patients as needed.
• Exhibits a positive, courteous, respectful, and helpful attitude towards patients, team members, payers, and management. Contributes team effort by accomplishing related tasks as needed and other duties as assigned.
• Research proper billing policies and procedures for all payer types, ensuring claims are processed correctly against industry and government standards and regulations, adhere to company compliance, integrity, patient privacy, and ethical billing practices.
• 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.
  
  

Education/Learning Experience

• Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification
• Desired: Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience
  
  

Work Experience

• Required: 1+ years’ Medicare and Medical benefit verification experience
• Desired: 3+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience
  
  

Skills/Knowledge

• Required: Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits, Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, basic math and analytical skills, Intermediate typing/keyboarding skills.
• Desired: Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience
  
  

Licenses/Certifications

• Required: None
• Desired: Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB)
  
  

Behavior Competencies

• 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 skills
  
  

Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.

A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.

We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Pharmaceutical Manufacturing

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