Medical Benefits Verification Specialist

Onco360 Oncology Pharmacy · Houston, TX · 3 wk ago

Information Technology$23/hrFull-time

About the role

Onco360 Pharmacy is looking for a Medical Benefits Verification Specialist for our Pharmacy located in Houston, TX. Work Hours: Monday-Friday 8:30-5 EST, may adjust according to Time Zone of candidate. Starting salary at $23/hour. We also offer quarterly incentive bonuses.

Responsibilities

The Medical Benefit Verification Specialist will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and investigate/identify authorization requirements needed to obtain medication coverage.

Verify Government payer (i.e. Medicare and Medicaid) eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile.
Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile.
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 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.

Requirements

High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification. 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 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.

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.

Benefits