Pharmacy Benefit Verification Specialist

Onco360; Village of New Hyde Park (NY); On-site; USD 28,000 - 40,000; Full time

Benefits offered by this job

401k match

PTO & Holidays

Tuition reimbursement

Floating holiday

Referral incentive

Life insurance

Short/long-term disability

Job summary

Onco360 is seeking a Pharmacy Benefit Verification Specialist for our New Hyde Park, NY site. You will investigate, verify, and load patient insurances and pharmacy benefits, run claim tests, and document outcomes in CPR+ to support accurate dispensing.

The role requires a strong understanding of PBMs, Medicare/Medicaid, NDC terminology, and benefits coordination, with a high attention to detail and customer-facing communication.

Qualifications

• Required: High School Diploma or GED; Pharmacy, medical billing, or benefits verification experience preferred.
• Desired: Associate degree or equivalent; PTCB certification; specialty pharmacy experience.

Responsibilities

• Verify and load patient insurances (medical and pharmacy) and benefits.
• Run test claims to obtain valid responses and determine reimbursement.
• Coordinate with providers, patients, and operations for accurate coverage.
• Maintain patient setup and ensure demographic/insurance data in CPR+.
• Assist with authorizations, LOAs, and TOAs for applicable plans.
• Ensure compliance with laws and company policies.

Skills

Pharmacy benefits verification

Medicare/Medicaid knowledge

NCPDP claims

Coordination of benefits

Pharmacy terminology

Data entry accuracy

Attention to detail

Communication skills

Education

High School Diploma or GED

Associate degree or equivalent

Certified Pharmacy Technician (PTCB)

Tools

CPR+ system

Job description

Onco 360 is aware that scammers are posing as representatives of our company and recruiting team. These individuals may contact you with fraudulent interview invitations or job offers in an attempt to obtain personal or financial information. Communication will only come from our official company email domain (@Onco360.com). Please be vigilant and keep the following security guidelines in mind:

• We do not conduct interviews exclusively via text message or email.
• We will never charge hiring-related fees such as applications, training, equipment, or background checks.
• We will never text or email you to ask for bank account information, social security number, identification documents, or payment details before you sign a verified offer.

All candidates will speak with an Onco360 recruiter before receiving a job offer. If you receive a suspicious outreach or interview invitation, do not share personal information or click on any unknown links. If you believe you have been contacted by a scammer impersonating our organization, please contact us directly through our official website.

Location: New Hyde Park, NY

Job Id:5880

# of Openings:1

Are you someone looking for professional career growth?Onco360 Pharmacy is looking forPharmacy Benefit Verification Specialistsfor our Pharmacy located in New Hyde Park, NY.

Shift times between 8am and 8pm.

**Starting salary at $25/HR and up**

Sign-On Bonus: $5,000 for employees starting before December 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
• 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.