Pharmacy Benefit Verification Specialist

Onco360 Oncology Pharmacy; Houston (TX); On-site; USD 27,000 - 39,000; Full time

Benefits offered by this job

401k with match

Paid Time Off

Paid Holidays

Tuition Reimbursement

Floating Holiday

Referral Incentive

Paid Life Insurance

Short & long-term disability

Job summary

Onco360 Oncology Pharmacy in Houston, TX is seeking a Pharmacy Benefit Verification Specialist to verify and load patient insurance information, determine coverage, and support providers and patients. The role includes coordinating benefits and authorizations for pharmacy and medical claims, while upholding privacy and regulatory standards.

Eligibility processing, CPR+ system use, and seamless collaboration with operations will be essential in delivering timely, accurate benefit responses for

Qualifications

• 1+ years pharmacy or benefit verification experience.
• High School Diploma or GED required.
• Associate degree or PT/CB certification desired.

Responsibilities

• Investigate, review, and load accurate patient insurances.
• Perform full benefits verification for pharmacy and medical benefits.
• Run test claims to obtain valid claim responses and determine coverage.
• Coordinate authorizations and TOAs for applicable claims.
• Maintain patient confidentiality and comply with regulations.

Skills

PBM knowledge

NDC billing

Coordination of benefits

Medicare/Medicaid knowledge

Communication skills

Detail-oriented

Time management

Education

High School Diploma or GED

Associate degree or PT/CB Cert

Tools

CPR+ system

E1 check

Job description

Location: Houston, TX

Job Id:5600

# of Openings:1

Are you someone looking for professional career growth?Onco360 Pharmacy is looking forPharmacy Benefit Verification Specialistsfor our Pharmacy located in Houston, TX.

Shift times between 8am and 8pm.

**Starting salary at $24HR and up**

Sign-On Bonus: $5,000 for employees starting before September 30th, 2026.

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

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.

• 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.
• Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement, 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.
• Maintain 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.
• 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 pharmacy or benefit verification experience
  • Desired:3+ years pharmacy or benefit verification experience
• Skills/Knowledge
  • 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

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 seekingPharmacy Benefit Verification Specialists who go above and beyond for our patients,and also passionate about helping others.