Pharmacy Benefit Verification Specialist

About the role

Are you someone looking for professional career growth? Onco360 Pharmacy is looking for Pharmacy Benefit Verification Specialists for our Pharmacy located in Waltham, MA. Onco360 is a closed‑door specialty pharmacy that focuses on patients undergoing cancer treatment. We strive to meet and exceed their needs and are seeking Pharmacy Benefit Verification Specialists who go above and beyond for our patients and are passionate about helping others.

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 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