Remote Pharmacy Benefit Verification Specialist - Oncology

Onco360 Oncology Pharmacy; Pittsburgh (Allegheny County); On-site; USD 27,000 - 39,000; Full time

Benefits offered by this job

Medical Insurance

Dental & Vision Insurance

401k with match

Paid Time Off

Tuition Reimbursement

Paid Volunteer Day

Floating Holiday

Referral Incentive

Life Insurance

Disability Insurance

Job summary

Onco360 Pharmacy is seeking a Pharmacy Benefit Verification Specialist to join our specialty oncology team. The role involves verifying insurance coverage, loading patient data in CPR+ and resolving benefit questions for providers and patients.

The ideal candidate has 1+ year of pharmacy or benefits verification experience, strong knowledge of Medicare/Medicaid, and a Pharmacy Technician license where required. A sign-on bonus of $5,000 is offered for qualifying hires.

Qualifications

• High School Diploma or GED required; experience in Pharmacy, Medical Billing, or Benefits Verification preferred.
• Desired: Associate degree or equivalent; PTCB certification; Specialty pharmacy experience.
• 1+ year pharmacy or benefit verification experience required.
• Desired: 3+ years pharmacy or benefit verification experience.
• Pharmacy Technician License/Registration with Board of Pharmacy as required by state law.
• Knowledge of Medicare, Medicaid, and commercial insurance.

Responsibilities

• Investigate, review, and load accurate patient insurances for pharmacy and medical coverage.
• Run test claims to obtain valid insurance responses for medications.
• Identify authorization requirements to obtain coverage and enroll patients in copay programs.
• Ensure accurate benefit documentation in CPR+ for prescription orders.
• Perform benefits verification and determine optimal reimbursement.
• Request medical authorizations, LOAs, and TOAs for applicable claims.
• Maintain compliance with laws, ethics, and company policies.

Skills

Pharmacy benefit verification

PBM contracts

Medicare knowledge

Medicaid knowledge

NCPDP claims

Coordination of benefits

NDC billing

Pharmacy terminology

Basic math

Typing

Education

High School Diploma or GED

Associate degree or equivalent

Certified Pharmacy Technician (PTCB)

Job description

Onco360 Pharmacy is seeking a Pharmacy Benefit Verification Specialist to join our specialty oncology team. The role involves verifying insurance coverage, loading patient data in CPR+ and resolving benefit questions for providers and patients.

The ideal candidate has 1+ year of pharmacy or benefits verification experience, strong knowledge of Medicare/Medicaid, and a Pharmacy Technician license where required. A sign-on bonus of $5,000 is offered for qualifying hires.