Pharmacy Benefit Verification Specialist

Job summary

The specialist investigates and reviews patient insurance coverage, assigns coordination of benefits, and runs test claims to ensure accurate medication coverage. They also facilitate medical authorizations and maintain accurate patient documentation within the CPR+ system.

Job details

Full-Time position may work remotely but MUST HAVE ACTIVE COLORADO PHARMACY TECHNICIAN credentials from the State Board of Pharmacy. We are seeking a Pharmacy Benefit Verification Specialist at our Specialty pharmacy working in Mountain Time Zone. This will be a Full-Time position. This is a remote/hybrid opportunity, Shift times start at 10am Mountain Time Zone until 8pm Mountain Time Zone. **Starting salary at $25HR and up** Sign-On Bonus: $5,000 for employees starting before October 31, 2026. We also offer quarterly incentive bonuses. We offer a variety of benefits including: * Medical, Dental & Vision insurance * 401k with a match * Paid Time Off and Paid Holidays * Tuition Reimbursement * Paid Volunteer Day * Floating Holiday * Referral Incentive * Paid Life, and short & long-term disability insurance Pharmacy Benefit Verification Summary 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 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. They will ensure accurate benefit documentation is made for all prescription orders. Pharmacy Benefit Verification Specialist Major Responsibilities: * Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests. * Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information. * Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information. * Performs 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 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 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 compliance with professional practice and patient confidentiality laws * Contributes to team effort by accomplishing related tasks as needed and other duties as assigned. * Conducts 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. Pharmacy Benefit Verification Specialist Qualifications: * Education/Learning Experience * Required: 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 * Required: 1+ years pharmacy or benefit verification experience * Desired: 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 skill Onco360 is a Closed door specialty pharmacy that focuses on patients who are currently undergoing cancer treatment. Our patients are important to us, so we always strive to meet and exceed their needs. We are seeking Pharmacy Benefit Verification Specialists who go above and beyond for our patients, and also passionate about helping others.

What you’ll do

The specialist investigates and reviews patient insurance coverage, assigns coordination of benefits, and runs test claims to ensure accurate medication coverage. They also facilitate medical authorizations and maintain accurate patient documentation within the CPR+ system.

Requirements

Candidates must have a High School Diploma or GED and active Colorado Pharmacy Technician credentials. At least one year of experience in pharmacy or benefit verification is required, with preference given to those with specialty pharmacy experience.

Benefits

• Medical insurance • Dental insurance • Vision insurance • 401k with a match • Paid Time Off • Paid Holidays • Tuition Reimbursement • Paid Volunteer Day • Floating Holiday • Referral Incentive • Paid Life insurance • Short-term disability insurance • Long-term disability insurance

Listed skills

• Time management · Preferred
• Communication Skills · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Pharmacy benefit verification
• Medical billing
• Insurance verification
• PBM contracts
• Medicare
• Medicaid
• Commercial insurance
• NCPDP claim resolution
• Coordination of benefits
• NDC medication billing
• Pharmacy terminology
• Analytical skills
• Time-management
• Communication skills
• CPR+ system
• Copayment Collection And Processing
• Pharmacy Operations
• Productivity Improvement
• Ability To Meet Deadlines
• Time Off Management
• Pharmacy Experience
• Ethical Standards And Conduct
• Analytical Skills
• Billing
• Medical Billing
• Management Of Cancer
• Certified Pharmacy Technician
• General Mathematics
• Interpersonal Communications
• Medical Prescription
• Operations
• Medical Privacy
• Pharmacy Benefit Management
• State Laws
• Time Management
• Typing
• Writing
• Coordinating
• National Drug Code (NDC)
• Detail Oriented

Job areas

• Healthcare
• Customer Service & Support
• Administrative
• Benefit Verification Specialist
• Compensation / Benefits Specialist
• Government Social Benefits Officials
• Compensation, Benefits, and Job Analysis Specialists