Pharmacy Benefits Verification Specialist

About the role

Onco360 Pharmacy is seeking Pharmacy Benefit Verification Specialists for our Louisville, KY location. Shifts are available between 8am and 8pm. Starting salary is $22/hr with a sign-on bonus of $5,000 for those starting before August 31, 2026. Additional benefits include a 401(k) with a match, medical, dental, vision, and life insurance, paid time off, holidays, tuition reimbursement, and more.

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 to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profiles.
• 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 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 standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable 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.