Medical Benefits Verification Specialist

Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. A career with us is more than just a job — it’s an opportunity to connect and care for our patients, providers, communities, and each other.

About the role

The Medical Benefit Verification Specialist will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and identify authorization requirements needed to obtain medication coverage. They will ensure accurate insurance benefit documentation is made for specific IV and oral therapy orders.

Responsibilities

• Verify Government payer (i.e. Medicare and Medicaid) eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contacting Medicare or other relevant government payers to confirm coverage and benefits for specific services.
• Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. Confirm patient eligibility and benefits with various commercial insurance carriers (i.e. Aetna, Humana, Anthem, Cigna, etc.).
• Provide thorough, accurate, and timely responses to requests from pharmacy operations, providers, and/or patients regarding benefit information and patient copays, deductibles, and Out-of-Network responsibilities.
• Determine optimal reimbursement based on medical plan and dispensing location, 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.
• Ensure complete and accurate patient setup in CPR+ system including patient demographic and insurance information, doctors’ notes, assessments, and lab reports.
• Communicate succinctly and professionally both verbally and through written correspondence with physician offices, nurses, insurance companies, and patients as needed. Exhibit a positive, courteous, respectful, and helpful attitude towards patients, team members, payers, and management. Contribute to team effort by accomplishing related tasks as needed and other duties as assigned.
• Research proper billing policies and procedures for all payer types, ensuring claims are processed correctly against industry and government standards and regulations, adhere to company compliance, integrity, patient privacy, and ethical billing practices.
• 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.

Requirements

• High School Diploma or GED.
• 1+ years’ Medicare and Medical benefit verification experience.
• Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits.
• Understanding of Medicare Parts A, B, C, and D, as well as relevant laws and guidelines.
• NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes.
• Basic math and analytical skills, intermediate typing/keyboarding skills.
• 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.

Qualifications

Desired:

• Associate degree or equivalent program from a 2-year program or technical school.
• Certified Pharmacy Technician (PTCB).
• 3+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience.
• Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience.
• Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB).

Benefits

• 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.
• Quarterly incentive bonuses.

Pay

Starting salary at $23/hour.

Schedule

Monday–Friday, 8:30 AM–5:00 PM EST.