Senior Pharmacy Benefit Verification Specialist at Onco360

Woodridge, Illinois, United States -

Full Time

Start Date

Immediate

Expiry Date

06 Aug, 26

Salary

27.0

Posted On

08 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Pharmacy Insurance Verification, Benefit Verification, PBM And Medical Contracts, Medicare Knowledge, Medicaid Knowledge, Commercial Insurance, NCPDP Claim Resolution, Coordination Of Benefits, NDC Medication Billing, Pharmacy Terminology, Analytical Skills, Typing, Specialty Pharmacy, Leadership Skills, Interpersonal Communication, Time Management

Industry

Pharmaceutical Manufacturing

Description

Are you someone looking for professional career growth? Onco360 Pharmacy is looking for Senior Pharmacy Benefit Verification Specialist for our Pharmacy located in Woodridge, IL. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Current shift available: 9:30am-6:00pm CST **Starting salary at $27HR and up** We offer a great benefits including: * Medical; Dental; Vision * 401k with a match * Paid Time Off and Paid Holidays * Tuition Reimbursement * Company paid benefits – life; and short and long-term disability Senior Pharmacy Benefit Verification Specialist Major Responsibilities: The Senior Benefit Verification Specialist will work closely with the Senior Manager, Patient Benefits to ensure completion of challenging cases and escalations in their designated vertical. Senior Benefits Verification Specialists 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. They may also assist with training employees, and other duties as assigned. * Works and resolve difficult or escalated cases to assist in processing prescription orders * Participates in the orientation and training of benefit verification specialists within workflow vertical * Escalates workflow/process improvement ideas to leadership * 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. Senior Pharmacy Benefit Verification Specialist Qualifications: * Education/Learning Experience * Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification * Desired: Associates or Bachelor’s Degree, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience * Work Experience * Required: 2+ 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. Desired: Specialty pharmacy experience, leadership skills * Licenses/Certifications * Required: Registration with Board of Pharmacy as required by state law * Desired: Certified Pharmacy Technician (PTCB) * 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 skills

Responsibilities

The Senior Benefit Verification Specialist manages complex insurance cases, verifies patient coverage, and ensures accurate benefit documentation for prescription orders. They also assist in training new employees and resolving escalated workflow issues to optimize reimbursement.