Pharmacy Benefit Verification Specialist

Onco360; Waltham (MA); On-site; USD 28,000 - 40,000; Full time

Benefits offered by this job

401k match

Paid time off

Paid holidays

Tuition reimbursement

Floating holiday

Referral incentive

Life insurance

Disability insurance

Job summary

Onco360 is seeking a Pharmacy Benefit Verification Specialist in Waltham, MA, to verify patient insurance benefits and load accurate data in CPR+ for pharmacy orders. The role focuses on coordination of benefits, test claims, and ensuring timely, precise benefit information for providers and patients.

The candidate should have 1+ year of pharmacy or benefit verification experience, with High School Diploma or GED, and ideally an Associate degree or PTCB certification. Relocation is not indicated.

Qualifications

• High School Diploma or GED required.
• 1+ year pharmacy or benefit verification experience required.
• Associate degree or equivalent program desirable; PTCB certification preferred.
• Experience with Medicare/Medicaid and commercial insurance advantageous.

Responsibilities

• Verify patient insurance benefits and ensure accurate loading in CPR+ system.
• Determine authorization requirements for medication coverage and enroll patients in copay programs.
• Communicate benefit information to pharmacy operations, providers and patients.
• Perform full benefits verification across pharmacy and medical benefits.
• Run test claims to obtain valid adjudication and guide dispensing."
• Assist with medical authorizations, LOAs, and TOAs as applicable.

Skills

Pharmacy insurance

Benefit verification

PBM contracts

Medicare knowledge

Medicaid knowledge

Insurance coordination

NDC billing

Typing/keyboard

Education

High School Diploma or GED

Associate degree or equivalent

PTCB certification (optional)

Specialty pharmacy experience (desired)

Tools

CPR+ system

Job description

Location: Waltham, MA

Job Id:5751

# of Openings:1

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

Shift times between 8am and 8pm.

**Starting salary at $25/HR 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
• 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.