Pharmacy Benefit Verification Specialist

About the role

Full‑time Pharmacy Benefit Verification Specialist position (remote/hybrid) requiring active New Mexico Pharmacy Technician credentials. Works in the Mountain Time Zone, shift 10 am – 8 pm MT. Onco360 is a closed‑door specialty pharmacy serving patients undergoing cancer treatment.

Responsibilities

• Investigate, review, and load accurate patient insurances (medical and pharmacy), assign coordination of benefits, run test claims to obtain valid insurance responses on patient medications.
• Identify authorization requirements needed for medication coverage and enroll eligible patients in copay‑card assistance programs.
• Ensure accurate benefit documentation for all prescription orders.
• Practice first‑call resolution to help health‑care providers and patients with 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 demographic and insurance information.
• Perform full benefits verification for pharmacy and/or medical benefits using 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, determine optimal reimbursement, document outcome in CPR+ system, and assign order to appropriate dispensing pharmacy.
• Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, Medicare, or facility medication claims.
• Maintain a safe and clean pharmacy by complying with procedures, rules, regulations, and professional practice and patient confidentiality laws.
• Contribute to team effort by accomplishing related tasks as needed and other duties as assigned.
• Conduct job responsibilities in accordance with the Company’s Code of Business Conduct and Ethics, policies, 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.
• Experience: 1+ years pharmacy or benefit verification experience required; 3+ years desired. Previous experience in pharmacy, medical billing, or benefits verification desired.
• Credentials: Active New Mexico Pharmacy Technician certification from the State Board of Pharmacy required; Certified Pharmacy Technician (PTCB) desired.
• Specialty pharmacy experience desired.

Skills

• Required: Pharmacy insurance and benefit verification; PBM and medical contracts; knowledge of Medicare, Medicaid, and commercial insurance; pharmacy test claim and NCPDP claim rejection resolution; coordination of benefits; NDC medication billing; pharmacy/healthcare‑related knowledge; pharmacy terminology (sig codes, Roman numerals); brand/generic medication names; basic math and analytical skills; intermediate typing/keyboarding.
• Desired: (same as required plus) Associate degree, PTCB, specialty pharmacy experience.
• Behavior competencies: Independent worker; good interpersonal skills; excellent verbal and written communication; ability to work independently, efficiently meet deadlines, be flexible; detail‑oriented; great time‑management.

Benefits

• Medical, Dental & Vision insurance
• 401k with company match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Paid Volunteer Day
• Floating Holiday
• Referral Incentive
• Paid Life, short‑term and long‑term disability insurance

Pay

Starting salary at $23 per hour and up. Sign‑on bonus of $5,000 for employees who start before October 31, 2026. Quarterly incentive bonuses also offered.

Schedule

Full‑