Pharmacy Benefits Verification Specialist

Shift time: Monday through Friday, 10:00 AM – 6:30 PM EST. Starting salary at $25/hr and up. Sign-on bonus: $5,000 for employees starting before August 31, 2026. Quarterly incentive bonuses available.

About the Role

Onco360 is a closed-door specialty pharmacy focused on patients undergoing cancer treatment. The Benefit Verification Specialist will investigate, review, and load accurate patient insurances—including medical and pharmacy coverage—assign coordination of benefits, run test claims to obtain valid insurance responses on patient medications, identify authorization requirements needed for medication coverage, and enroll eligible patients in copay card assistance programs. They ensure accurate benefit documentation for all prescription orders.

Responsibilities

• Practice first-call resolution to assist healthcare providers and patients with pharmacy needs, answering 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 the CPR+ system, including patient demographic and insurance information.
• Perform full benefits verification for pharmacy and/or medical benefits using electronic resources and E1 check to load primary, secondary, tertiary, and medical insurances to the patient profile.
• Run test claims at each licensed pharmacy site to obtain a valid claim response, determine optimal reimbursement, and document the outcome of benefits review in the CPR+ system for operations.
• Facilitate the process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, Medicare, or facility medication claims.
• Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations, including professional practice and patient confidentiality laws.
• Contribute to team effort 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, procedures, and applicable federal/state laws.

Requirements

• High school diploma or GED.
• 1+ years of pharmacy or benefit verification experience.
• Pharmacy insurance and benefit verification knowledge.
• Understanding of PBM and medical contracts, Medicare, Medicaid, and commercial insurance.
• Experience with pharmacy test claims, NCPDP claim rejection resolution, and coordination of benefits.
• Knowledge of NDC medication billing, pharmacy terminology (sig codes, Roman numerals, brand/generic names), and basic math/analytical skills.
• Intermediate typing/keyboarding skills.
• Independent worker with excellent interpersonal, verbal, and written communication skills.
• Ability to work efficiently to meet deadlines, be flexible, detail-oriented, and manage time effectively.

Qualifications (Preferred)

• Associate degree or equivalent from a 2-year program or technical school.
• Certified Pharmacy Technician (PTCB).
• Specialty pharmacy experience.
• 3+ years of pharmacy or benefit verification experience.

Benefits

• Medical, dental, and vision insurance.
• 401k with company match.
• Paid time off and paid holidays.
• Tuition reimbursement.
• Paid volunteer day.
• Floating holiday.
• Referral incentive.
• Paid life, short-term, and long-term disability insurance.