Medical Benefits Verification Supervisor

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 Benefits Verification Supervisor supports the Medical Benefits Verification Specialist roles while performing insurance authorization and verification for all patients scheduled for services. The Supervisor investigates, reviews, and loads accurate patient insurance for medical coverage, assigns coordination of benefits, and identifies authorization requirements needed to obtain medication coverage.

Responsibilities

• Support staff in verifying Commercial and Government payer eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile, including 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 (e.g., Aetna, Humana, Anthem, Cigna).
• Provide thorough, accurate, and timely responses to requests from pharmacy operations, providers, and/or patients regarding benefit information, patient copays, deductibles, and Out-of-Network responsibilities.
• Facilitate the process for requesting medical authorizations, Single Case Agreements, Letter of Agreements, and Terms of Agreement for applicable commercial, Medicaid, Medicare, or facility medication claims.
• Investigate payer plans: research and document benefit plan specifics, including cost-share responsibilities and restrictions; address intricate benefit verification issues such as those involving high-cost or specialized treatments, denials, and appeals.
• Develop expertise in insurance policies, coverage terms, and complex billing practices; identify appropriate clinical records and submit authorization requests to insurance companies based on plan requirements for approval.
• Handle complex cases involving high-cost or specialized treatments, denials, and appeals.
• Collaborate across departments, working closely with clinical staff, billing and coding teams, and administrative teams to resolve insurance issues and ensure seamless patient care.
• Act as the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated.

Requirements

• High School Diploma or GED.
• 3+ years’ Medicare and Medical benefit verification experience.
• Previous leadership 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 with good interpersonal skills, excellent verbal and written communication skills.
• Ability to work independently, meet deadlines, and be flexible; detail-oriented with great time-management skills.

Qualifications (Preferred)

• Associate degree or equivalent program from a 2-year program or technical school.
• Certified Pharmacy Technician (PTCB).
• 5+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience.
• 1+ years supervisor 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 is $61,000 annually.

Schedule

Monday–Friday, 8:30 AM–5:00 PM EST.