Pharmacy Benefit Verification Specialist

Responsibilities

• PRACTICES FIRST CALL RESOLUTION TO HELP HEALTH CARE PROVIDERS AND PATIENTS WITH THEIR PHARMACY NEEDS, ANSWERING QUESTIONS AND REQUESTS.
• PROVIDES THOROUGH, 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.
• 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.
• MANTAIN A SAFE AND CLEAN PHARMACY BY COMPLYING WITH PROCEDURES, RULES, AND REGULATIONS AND COMPLIANCE WITH PROFESSIONAL PRACTICE AND PATIENT CONFIDENTIALITY LAWS.

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.