The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, and run test claims to obtain valid insurance responses for patient medications. Responsibilities also include facilitating the process for requesting medical authorizations and ensuring accurate benefit documentation for all prescription orders.
Requirements summary
Required qualifications include a High School Diploma or GED and at least one year of experience in pharmacy or benefit verification, along with knowledge of pharmacy insurance, PBM contracts, Medicare/Medicaid, and coordination of benefits. Desired qualifications include an Associate's degree or Certified Pharmacy Technician status.
high schoolassociate degreeprofessional certificateComplianceFirst Call ResolutionAuthorization RequirementsTime-ManagementBenefit VerificationCoordination Of BenefitsInsurance CoverageMedical AuthorizationsPatient SetupElectronic ResourcesClaim ResponseTest ClaimsCopay Card AssistanceLOAsE1 CheckTOAs
Job description
Are you someone looking for professional career growth? Onco360 Pharmacy is looking for Pharmacy Benefit Verification Specialists for our Pharmacy located in Waltham, MA. Work Hours: Monday-Friday shifts available; some weekends as needed. **Starting salary at $25.00/hr and up*
We also offer quarterly incentive bonuses. We offer a variety of benefits including:
Medical, Dental & Vision insurance
401k with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Paid Volunteer Day
Floating Holiday
Referral Incentive
Paid Life, and short & long-term disability insurance
Pharmacy Benefit Verification Specialist Summary
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.
Pharmacy
Benefit
Verification
Specialist
Major
Responsibilities:
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.
Benefits
Dental Insurance
Paid Holidays
Paid Time Off
Vision Insurance
Short Term Disability Insurance
Long Term Disability Insurance
Medical Insurance
Paid Life Insurance
Floating Holiday
Tuition Reimbursement
Paid Volunteer Day
401k With A Match
Referral Incentive
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.
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.
Behavior Competencies
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 seeking Pharmacy Benefit Verification Specialists who go above and beyond for our patients, and also passionate about helping others.
