Pharmacy Benefits Verification Specialist

About the role

Onco360 Pharmacy is seeking Pharmacy Benefit Verification Specialists for our Buffalo, NY location. Shifts are Monday through Friday from 10am-6:30pm EST.

Responsibilities

• Prioritize first-call resolution to assist health care providers and patients with their pharmacy needs, addressing 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 on patients for pharmacy 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, documenting outcomes in CPR+ system for operations and ensuring 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 adhering to procedures, rules, and regulations, and complying with professional practice and patient confidentiality laws.
• Contribute to the team by completing related tasks as needed and other duties as assigned.
• Comply 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: 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.
• Experience: Required - 1+ years pharmacy or benefit verification experience. Preferred - 3+ years pharmacy or benefit verification experience.
• Skills: 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.