Pharmacy Benefit Verification Specialist

About the role

Onco360 Pharmacy is seeking Pharmacy Benefit Verification Specialists for our Houston, TX location. This position offers remote work opportunities for those with active Arizona Pharmacy Technician credentials.

Responsibilities

• Investigate, review, and load accurate patient insurances, including medical and pharmacy coverage.
• Assign coordination of benefits and run test claims to obtain a valid insurance response on patient medications.
• Investigate/identify authorization requirements needed to obtain medication coverage and enroll eligible patients in copay card assistance programs.
• Ensure accurate benefit documentation is made for all prescription orders.
• Provide thorough, accurate, and timely responses to requests from pharmacy operations, providers, and/or patients regarding benefit information.
• Perform full benefits verification on patients for pharmacy benefits and/or medical benefits using electronic resources and E1 checks.
• Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement.
• Document outcomes of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy.
• Facilitate the process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.
• Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and adhering to professional practice and patient confidentiality laws.
• Contribute to team efforts 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 and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and professional standards.

Qualifications

• Education/Learning Experience: Required - High School Diploma or GED. Preferred - Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience.
• Work Experience: Required - 1+ years pharmacy or benefit verification experience. Preferred - 3+ years pharmacy or benefit verification experience.
• Skills/Knowledge: Required - Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
• Behavior Competencies: Required - Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills.

Pay

Starting salary at $24/hr and up. Sign-On Bonus: $5,000 for employees starting before September 30th, 2026. Quarterly incentive bonuses offered.

Schedule

Monday through Friday between the hours of 8am to 8pm.

Benefits

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