Senior Pharmacy Benefit Verification Specialist

Senior Pharmacy Benefit Verification Specialist Onco360 - 3.4 Waltham, MA Job Details From $30 an hour 1 day ago Benefits Paid holidays Disability insurance Health insurance Dental insurance Tuition reimbursement Paid time off Vision insurance 401(k) matching Qualifications Medical claims processing Medicare Basic math High school diploma or GED Medical billing Registered Pharmacy Technician Typing Full Job Description Are you someone looking for professional career growth? Onco360 Pharmacy is looking for Senior Pharmacy Benefit Verification Specialist for our Pharmacy located in Waltham, MA . Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.

Current shift available:

10:30am-7:00pm EST •Starting salary at $30/HR and up•We offer a great benefits including: Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits - life; and short and long-term disability

Senior Pharmacy Benefit Verification Specialist Major Responsibilities:

The Senior Benefit Verification Specialist will work closely with the Senior Manager, Patient Benefits to ensure completion of challenging cases and escalations in their designated vertical. Senior Benefits Verification Specialists 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. They may also assist with training employees, and other duties as assigned. Works and resolve difficult or escalated cases to assist in processing prescription orders Participates in the orientation and training of benefit verification specialists within workflow vertical Escalates workflow/process improvement ideas to leadership 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.

Senior Pharmacy Benefit Verification Specialist Qualifications:

Education/Learning Experience Required:

High School Diploma or GED. Previous Experience in

Pharmacy, Medical Billing, or Benefits Verification Desired:

Associates or Bachelor's Degree, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience

Work Experience Required:

2+ 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.

Desired:

Specialty pharmacy experience, leadership skills

Licenses/Certifications Required:

Registration with Board of Pharmacy as required by state law

Desired:

Certified Pharmacy Technician (PTCB)

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