Pharmacy Benefits Verification Specialist

About the role

Onco360 Pharmacy is seeking Pharmacy Benefit Verification Specialists for our pharmacy located in Woodridge, IL. Shifts are available between 8am and 8pm.

Responsibilities

• PRACTICES FIRST CALL RESOLUTION: Help health care providers and patients with their pharmacy needs, answering questions and requests.
• THROUGH, ACCURATE AND TIMELY RESPONSES: Provide thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information.
• COMPLETE AND ACCURATE PATIENT SETUP: Ensure complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
• FULL BENEFIT VERIFICATION: Perform full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profile.
• RUN TEST CLAIMS: 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 MEDICAL AUTHORIZATIONS: Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.
• MANTAIN SAFE AND CLEAN PHARMACY: Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
• TEAM CONTRIBUTION: Contribute to team effort by accomplishing related tasks as needed and other duties as assigned.
• JOB RESPONSIBILITIES: 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

• Educational Requirements: 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 Requirements: Required - 1+ years pharmacy or benefit verification experience. Preferred - 3+ years pharmacy or benefit verification experience.
• Skills and 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 skill.