Pharmacy Benefit Verification Specialist

Onco360; United States; Hybrid; USD 32,000 - 41,000; 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 for a remote/hybrid role in the Mountain Time Zone. Candidates must hold active New Mexico Pharmacy Technician credentials and have 1+ year of pharmacy/benefit verification experience.

The position includes a $23/hour starting wage plus a $5,000 sign-on bonus and quarterly incentives. The role focuses on accurate benefit documentation, first call resolution for providers and patients, and comprehensive verification across commercial,

Qualifications

• Required: High School Diploma or GED; Pharmacy, Medical Billing, or Benefits Verification experience preferred.
• Desired: Associate degree or equivalent program; Certified Pharmacy Technician (PTCB)
• Work Experience: 1+ years pharmacy or benefit verification experience; 3+ years preferred.
• Skills/Knowledge: Pharmacy insurance, Medicare/Medicaid, PBM contracts, NDC/billing, sig codes, data entry, and basic math.

Responsibilities

• Verify benefits for prescription orders and ensure accurate documentation in CPR+ system.
• Respond to pharmacy operations, providers, and patients regarding benefit information.
• Load patient demographics and insurance data; configure primary/secondary/tertiary coverage.
• Run test claims to determine reimbursement and document outcomes.
• Facilitate medical authorizations and LOAs/TOAs for applicable claims.
• Maintain compliance with laws and company policies.
• Support team with related tasks and maintain patient confidentiality.

Skills

Pharmacy insurance

Benefit verification

Medicare/Medicaid knowledge

NCPDP claims

Benefits coordination

Brand/generic names

Basic math

Typing/keyboard skills

Interpersonal skills

Education

High School Diploma or GED

Associate degree or 2-year program

PTCB certification

Job description

Location: Albuquerque, NM

Job Id:5755

# of Openings:1

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

We are seeking a Pharmacy Benefit Verification Specialist at our Specialty pharmacy working in Mountain Time Zone.This will be a Full-Time position. This is a remote/hybrid opportunity,

**Starting salary at $23HR 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

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.