Pharmacy Benefit Verification Specialist

Pharmacy Benefit Verification Specialist

Responsibilities

• PRACTICES FIRST CALL RESOLUTION TO HELP HEALTH CARE PROVIDERS AND PATIENTS WITH THEIR PHARMACY NEEDS, ANSWERING QUESTIONS AND REQUESTS.
• PURSUDES THROUGH, 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 BENEFIT VERIFICATION ON PATIENTS FOR PHARMACY BENEFITS AND/OR MEDICAL BENEFITS UTILIZING ELECTRONIC RESOURCES AND E1 CHECK TO LOAD PRIMARY, SECONDARY, TERTIARY, ETC. INSURANCES AND MEDICAL INSURANCES TO PATIENT PROFILE.
• RUNS 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.
• FACILITATES PROCESS FOR REQUESTING MEDICAL AUTHORIZATIONS, LOAs, AND TOAs FOR APPLICABLE COMMERCIAL, MEDICAID, AND MEDICARE, OR FACILITY MEDICATION CLAIMS.
• MANTAINS 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 NEEDS 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.

Qualifications

• REQUIRED: HIGH SCHOOL DIPLOMA OR GED. PREVIOUS EXPERIENCE IN PHARMACY, MEDICAL BILLING, OR BENEFIT VERIFICATION DESIRED.
• DESIRED: ASSOCIATE DEGREE OR EQUIVALENT PROGRAM FROM A 2 YEAR PROGRAM OR TECHNICAL SCHOOL, CERTIFIED PHARMACY TECHNICIAN (PTCB), SPECIALTY PHARMACY EXPERIENCE.
• REQUIRED: 1+ YEARS PHARMACY OR BENEFIT VERIFICATION EXPERIENCE. DESIRED: 3+ YEARS PHARMACY OR BENEFIT VERIFICATION EXPERIENCE.
• REQUIRED: PHARMACY TECHNICIAN LICENSE/REGISTRATION WITH BOARD OF PHARMACY, AS REQUIRED BY STATE LAW.
• REQUIRED: INTERMEDIATE TYPING/KEYBOARDING SKILLS.