Pharmacy Benefits Verification Specialist
Position Overview
Are you looking for professional career growth? Onco360 Pharmacy is seeking Pharmacy Benefit Verification Specialists for our Waltham, MA location. Shift times are Monday through Friday, 10am-6:30pm EST. Starting salary is $25/hr and up, with a sign-on bonus of $5,000 for those starting before August 31, 2026. Additional benefits include medical, dental, vision insurance, 401(k) with a match, paid time off, holidays, tuition reimbursement, volunteer days, floating holidays, referral incentives, life, short-term, and long-term disability insurance.
Major 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 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 the 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 the team 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: High School Diploma or GED. Previous experience in pharmacy, medical billing, or benefits verification. Desired: Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience.
- Work Experience: 1+ years pharmacy or benefit verification experience. Desired: 3+ years pharmacy or benefit verification experience.
- Skills/Knowledge: 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, Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
- Behavior Competencies: 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.
About the Role
Onco360 is a closed-door specialty pharmacy focused on patients undergoing cancer treatment. We strive to meet and exceed our patients' needs and seek Pharmacy Benefit Verification Specialists who go above and beyond for our patients and are passionate about helping others.
Benefits
We offer a variety of benefits including Medical, Dental & Vision insurance, 401(k) with a match, Paid Time Off and Paid Holidays, Tuition Reimbursement, Volunteering Days, Floating Holidays, Referral Incentives, and Paid Life, short-term, and long-term disability insurance.