Pharmacy Benefit Verification Specialist

About the role

As our company continues to grow, we strive to hire new team members with a passion for making a difference in our patient's lives. Full-Time position may work remotely but MUST HAVE ACTIVE PENNSYLVANIA PHARMACY TECHNICIAN credentials from the State Board of Pharmacy. Shift times are between 8am and 8pm. Starting salary at $24HR and up. Sign-On Bonus: $5,000 for employees starting before August 31, 2026. We also offer quarterly incentive bonuses.

Responsibilities

• Practice first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
• Provide thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information.
• Ensure complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
• Perform 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.
• Contribute to team effort by accomplishing related tasks as needed and other duties as assigned.

Qualifications

• High School Diploma or GED.
• 1+ years pharmacy or benefit verification experience.
• Pharmacy Technician License/Registration with Board of Pharmacy, as required by state law.

Preferred qualifications

• Associate degree or equivalent program from a 2 year program or technical school.
• Certified Pharmacy Technician (PTCB).
• Specialty pharmacy experience.
• 3+ years pharmacy or benefit verification experience.

Skills

• 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.

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