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Pharmacy Benefit Verification Specialist

Onco360 Oncology Pharmacy

Louisville (KY)

On-site

Full time

30+ days ago

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Job summary

An established industry player is seeking Pharmacy Benefit Verification Specialists to join their innovative team in Louisville. This role focuses on verifying patient insurance benefits and ensuring seamless access to necessary medications. You'll be part of a dedicated team, working to support healthcare providers and patients while maintaining compliance with professional standards. The position offers a competitive starting salary and a range of benefits, including 401k matching and paid time off. If you're passionate about healthcare and looking for a role that makes a difference, this opportunity is perfect for you.

Benefits

401k with a match
Paid Time Off
Paid Holidays
Tuition Reimbursement
Company paid benefits – life
Short and long-term disability

Qualifications

  • 1+ years of pharmacy or benefit verification experience required.
  • Knowledge of pharmacy terminology and insurance processes is essential.

Responsibilities

  • Investigate and load accurate patient insurances for medications.
  • Ensure accurate benefit documentation for all prescription orders.
  • Provide timely responses to pharmacy operations and patient requests.

Skills

Pharmacy insurance and benefit verification
PBM and Medical contracts
Knowledge of Medicare and Medicaid
Pharmacy test claim resolution
Coordination of benefits
Basic math and analytical skills
Intermediate typing/keyboarding skills

Education

High School Diploma or GED
Associate degree or equivalent

Job description

Location: Louisville, KY

Job Id: 3922

# of Openings: 6

Are you someone looking for professional career growth? Onco360 Pharmacy is looking for Pharmacy Benefit Verification Specialists for our Pharmacy located in Louisville, KY. Monday-Friday 11:30am-8pm est

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

Starting salary at $20/HR and up

We offer great benefits including:

  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Company paid benefits – life; and short and long-term disability

The Benefit Verification Specialist will:

  • Investigate, review, and load accurate patient insurances, including medical and pharmacy coverage.
  • Assign coordination of benefits and 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.
  • Ensure accurate benefit documentation is made for all prescription orders.
  • Practice first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
  • Provide thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information.
  • Ensure complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
  • Perform full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources and E1 check.
  • Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement, documenting the outcome of benefits review in CPR+ system.
  • Facilitate the 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.
  • Contribute to team effort by accomplishing related tasks as needed and other duties as assigned.
  • Conduct 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.

Licenses/Certifications

  • Required: Registration with Board of Pharmacy as required by state law.
  • Desired: Certified Pharmacy Technician (PTCB).

Additional Requirements:

  • 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.
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