Pharmacy Benefit Verification Specialist

Summary

The Pharmacy Benefit Verification Specialist will investigate, review, and load accurate patient insurances—including medical and pharmacy coverage—assign coordination of benefits, run test claims to obtain valid insurance responses on patient medications, identify authorization requirements, and enroll eligible patients in copay‑card assistance programs. The role ensures accurate benefit documentation for all prescription orders.

Major Responsibilities

• Practice first‑call resolution to assist health‑care providers and patients with pharmacy needs, answering questions and requests.
• Provide thorough, accurate, and timely responses to benefit information requests from pharmacy operations, providers, and patients.
• Ensure complete and accurate patient setup in the CPR+ system, including demographics and insurance information.
• Perform full benefits verification for pharmacy and medical benefits using electronic resources and E1 checks, loading primary, secondary, tertiary, etc., insurances to patient profiles.
• Run test claims at each licensed pharmacy site to obtain valid claim responses, determine optimal reimbursement, and document outcomes in CPR+ for operations and order routing.
• Facilitate requests for medical authorizations, letters of authorization (LOAs), and transfer of authority (TOAs) for commercial, Medicaid, Medicare, and facility medication claims.
• Maintain a safe and clean pharmacy by complying with procedures, rules, regulations, and patient confidentiality laws.
• Contribute to team effort by accomplishing related tasks and other duties as assigned.
• Conduct responsibilities in accordance with the Company’s Code of Business Conduct and Ethics, corporate policies, the Corporate Compliance Agreement, applicable federal and state laws, and professional standards.

Qualifications

• Education: High School Diploma or GED required; associate degree or equivalent from a 2‑year program or technical school desired.
• Pharmacy Technician License/Registration with the Pennsylvania State Board of Pharmacy (required).
• Previous experience in pharmacy, medical billing, or benefits verification: 1+ years required; 3+ years desired.
• Desired certifications: Certified Pharmacy Technician (PTCB) and specialty pharmacy experience.

Skills/Knowledge

• Pharmacy insurance and benefit verification, PBM and medical contracts.
• Understanding of Medicare, Medicaid, and commercial insurance.
• Pharmacy test claim and NCPDP claim rejection resolution.
• Coordination of benefits and NDC medication billing.
• Pharmacy terminology (sig codes, Roman numerals, brand/generic medication names).
• Basic math, analytical skills, and intermediate typing/keyboarding.

Behavior Competencies

• Independent worker with strong interpersonal skills.
• Excellent verbal and written communication.
• Ability to work independently, meet deadlines, and remain flexible.
• Detail‑oriented with strong time‑management.

Pay

• Starting salary: $24 per hour and up.
• Sign‑on bonus: $5,000 for employees starting before October 31, 2026.
• Quarterly incentive bonuses.

Benefits

• Medical, dental, and vision insurance.
• 401(k) with company match.
• Paid time off and paid holidays.
• Tuition reimbursement.
• Paid volunteer day.
• Floating holiday.
• Referral incentive.
• Paid life insurance, short‑term and long‑term disability insurance.

Schedule

Full‑time position; may work remotely but must hold active Pennsylvania Pharmacy Technician credentials. Shift times are between 8 am and 8 pm.