Medical Benefits Verification Supervisor

Onco360 Oncology Pharmacy; Louisville (KY); On-site; USD 52,000 - 70,000; Full time

Benefits offered by this job

401k with match

PTO & holidays

Tuition reimbursement

Floating holiday

Referral incentive

Life insurance

Disability insurance

Job summary

Onco360 Pharmacy in Louisville, KY is seeking a Medical Benefits Verification Supervisor to lead the benefits verification team and manage insurance authorization for oncology patients. The role focuses on verifying payer eligibility, loading benefits, coordinating coordination of benefits, and obtaining authorizations for medications, working closely with clinical and billing staff.

Starting salary is $61,000 annually with quarterly incentives; a comprehensive benefits package is offered.

Qualifications

• 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)

Responsibilities

• Verify payer plans: Research and document benefit plan specifics for various payer plans, including cost-share responsibilities and restrictions.
• Load insurance data to patient profiles and confirm coverage for services.
• Provide timely responses to requests from pharmacy operations, providers and patients regarding benefits and copays.
• Facilitate process for medical authorizations and related agreements for commercial, Medicaid, and Medicare.
• Collaborate with clinical staff, billing and coding teams, and administrative teams to resolve insurance issues.

Skills

Medicare verification

Medical billing

Benefits verification

Coordinating benefits

Communication skills

Education

High School diploma or GED

Associate degree or equivalent

Certified Pharmacy Technician (PTCB)

Job description

Position:Medical Benefits Verification Supervisor

Location: Louisville, KY

Job Id:5552

# of Openings:1

Are you someone looking for professional career growth?Onco360 Pharmacy is looking for aMedical Benefits Verification Supervisorfor our Pharmacy located in Louisville, KY.

Work Hours: Monday-Friday 8:30-5 EST.

**Starting salary is $61,000/annually**We also offer quarterly incentive bonuses.

We offer a variety of benefits including:

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

MedicalBenefits VerificationSpecialist Summary:

The Medical Benefits Verification Supervisor is responsible to support the Medical Benefits Verification Specialist roleswhile performing insurance authorization and verification for all patients scheduled for services. The Supervisor willinvestigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, andinvestigate/identify authorization requirements needed to obtain medication coverage.

MedicalBenefits VerificationSpecialist Major Responsibilities:

• Support staff in verifying Commercial and Government payer eligibility and benefits utilizing electronicresources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contactingMedicare 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.
• Facilitate process for requesting medical authorizations, Single Case Agreements, Letter of Agreements,and Terms of Agreement for applicable commercial, Medicaid, and Medicare, or facility medication claims.
• Investigate payer plans: Research and document benefit plan specifics for various payer plans, including cost-share responsibilities and restrictions. Address intricate benefit verification issues, such as those involvinghigh-cost or specialized treatments, denials, and appeals.
• Develop expertise: Maintain in-depth knowledge of insurance policies, coverage terms, and complex billingpractices. Identify the appropriate clinical records and submit the authorization request to the insurancecompany based on plan requirements for approval.
• Handle complex cases: Address intricate benefit verification issues, such as those involving high-cost orspecialized treatments, denials, and appeals.
• Collaborate across departments: Work closely with clinical staff, billing and coding teams, and administrativeteams to resolve insurance issues and ensure seamless patient care. Will be the liaison between the orderingphysician and insurance company to ensure all requirements to secure approval are identified andcommunicated.

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: 3+ years’ Medicare and Medical benefit verification experience, previous leadership experience
• Desired: 5+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verificationexperience, 1+ years supervisor 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)
• 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.