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, identify authorization requirements, and enroll eligible patients in copay‑card assistance programs. The role ensures accurate benefit documentation for all prescription orders and supports patients and providers throughout the pharmacy process.

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.
• 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 duties 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

• High School Diploma or GED (required).
• 1+ years pharmacy or benefit verification experience (required).
• Preferred: Associate degree or equivalent from a 2‑year program or technical school, Certified Pharmacy Technician (PTCB), specialty pharmacy experience.
• Desired: 3+ years pharmacy or benefit verification experience.

Skills

• 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 and NDC medication billing.
• Pharmacy terminology (sig codes, Roman numerals, brand/generic medication names).
• Basic math, analytical skills, and intermediate typing/keyboarding.
• Independent worker with strong interpersonal, verbal, and written communication skills.
• Detail‑oriented, excellent time‑management, and ability to meet deadlines while being flexible.

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, short‑term, and long‑term disability insurance

Pay

Starting salary $22 per hour and up. Sign‑on bonus of $5,000 for employees who start before October 31 2026. Quarterly incentive bonuses are also offered.

Schedule

Shift times between 8 am and 8 pm.