Pharmacy Benefits Verification Specialist

Onco360 Oncology Pharmacy; Woodridge (IL); On-site; USD 48,000 - 72,000; Full time

Benefits offered by this job

401k with a match

Paid Time Off

Tuition Reimbursement

Referral Incentive

Paid Life and Disability Insurance

Job summary

Onco360 Oncology Pharmacy in Woodridge, IL, is seeking Pharmacy Benefit Verification Specialists to support patient insurance needs effectively. The role requires verifying coverage and providing assistance to healthcare providers and patients.

The ideal candidate will possess a high school diploma, with relevant pharmacy experience preferred. Starting salary is $24 per hour, with opportunities for bonuses and comprehensive benefits including 401k matching and paid time off.

Qualifications

• 1+ years pharmacy or benefit verification experience required.
• Experience in Pharmacy, Medical Billing, or Benefits Verification preferred.

Responsibilities

• Verify patient insurance and medication coverage accurately.
• Assist healthcare providers and patients with pharmacy needs.
• Conduct complete benefits verification for pharmacy benefits.

Skills

Pharmacy insurance and benefit verification

Knowledge of Medicare, Medicaid, and commercial insurance

Excellent verbal and written communication skills

Independent worker

Detail-oriented

Education

High School Diploma or GED

Associate degree in relevant field (desired)

Certified Pharmacy Technician (PTCB) (desired)

Job description

Location: Woodridge, IL

Job Id: 5229

# of Openings: 4

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

Shift time: Monday through Friday 9:00am to 5:30 pm CST.

Starting salary at $24HR and up

Sign-On Bonus: $5,000 for employees starting before July 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

Responsibilities

• 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. 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 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.
• 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

• 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, 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 communication skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skill.

About Onco360

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 seeking Pharmacy Benefit Verification Specialists who go above and beyond for our patients, and also passionate about helping others.