Pharmacy Benefit Verification Specialist

Onco360; Pittsburgh (Allegheny County); Hybrid; USD 50,000 - 62,000; Full time

Benefits offered by this job

401k with match

Paid Time Off and Holidays

Tuition Reimbursement

Floating Holiday

Referral Incentive

Paid Life and disability insurance

Job summary

Onco360 is seeking a Pharmacy Benefit Verification Specialist in Pittsburgh, PA. The role focuses on verifying and loading patient insurance information for pharmacy and medical benefits, and coordinating authorizations to ensure coverage for oncology medications.

Responsibilities include running test claims, documenting outcomes in CPR+ and ensuring accurate patient data. Prior pharma verification experience and PA Pharmacy Technician credentials are required, with benefits including a sign-on

Qualifications

• 1+ years pharmacy or benefits verification experience.
• Knowledge of PBM contracts and medical coverage.
• Experience with NCPDP claims and denials resolution.

Responsibilities

• Investigate, review, and load accurate patient insurances (medical and pharmacy).
• Identify coordination of benefits and run test claims to obtain valid responses.
• Ensure patient setup in CPR+ with demographics and insurance data.
• Perform full benefits verification for pharmacy and medical benefits.
• Document outcomes of benefits review and route orders to dispensing site.
• Facilitate medical authorizations, LOAs, and TOAs for applicable claims.
• Maintain a safe, compliant pharmacy environment and patient confidentiality.
• Collaborate with team and complete related tasks as needed.
• Adhere to company policies, ethics, and applicable laws.

Skills

Pharmacy benefit verification

PBM and medical contracts

Medicare/Medicaid knowledge

NCPDP claim processing

Education

High School Diploma or GED

Associate degree or PTCB preferred

PTCB certification

Tools

CPR+ system

Job description

Location: Pittsburgh, PA

Job Id:5594

# of Openings:1

Full-Time position may work remotely but MUST HAVE ACTIVE PENNSYLVANIA PHARMACY TECHNICIAN credentials from the State Board of Pharmacy.

Onco360 Pharmacy is looking for Pharmacy Benefit Verification Specialists for our Specialty Oncology Pharmacy.

As our company continues to grow, we strive to hire new team members with a passion for making a difference in our patient's lives.

Shift times are between 8am and 8pm.

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

Sign-On Bonus: $5,000 for employees starting before October 31, 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
• Licenses/Certifications
  • Required: Pharmacy Technician License/Registration with Board of Pharmacy, as required by state law
• 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.