Onco360 Oncology Pharmacy
Pharmacy Benefit Verification Specialist
Onco360 Oncology Pharmacy, Waltham, Massachusetts, United States, 02254
Location:
Waltham, MA
Job Id:
3442# of Openings:
6Are you someone looking for professional career growth?
Onco360 Pharmacy is looking for
Pharmacy Benefit Verification Specialists
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.Starting salary at $20/HR and upWe offer great benefits including:401k with a matchPaid Time Off and Paid HolidaysTuition ReimbursementCompany paid benefits – life; and short and long-term disabilityThe Benefit Verification Specialist will: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.Enroll eligible patients in copay card assistance programs.Ensure accurate benefit documentation for all prescription orders.Practice first call resolution to help health care providers and patients with their pharmacy needs.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 CPR+ system including patient demographic and insurance information.Perform full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources.Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement.Document outcomes of benefits review in CPR+ system for 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.Contribute to team effort by accomplishing related tasks as needed and other duties as assigned.Conduct job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, and applicable laws.Education/Learning ExperienceRequired: 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 ExperienceRequired: 1+ years pharmacy or benefit verification experience.Desired: 3+ years pharmacy or benefit verification experience.Skills/KnowledgeRequired: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge 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.Licenses/CertificationsRequired: Registration with Board of Pharmacy as required by state law.Desired: Certified Pharmacy Technician (PTCB).Other RequirementsIndependent 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.
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Waltham, MA
Job Id:
3442# of Openings:
6Are you someone looking for professional career growth?
Onco360 Pharmacy is looking for
Pharmacy Benefit Verification Specialists
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.Starting salary at $20/HR and upWe offer great benefits including:401k with a matchPaid Time Off and Paid HolidaysTuition ReimbursementCompany paid benefits – life; and short and long-term disabilityThe Benefit Verification Specialist will: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.Enroll eligible patients in copay card assistance programs.Ensure accurate benefit documentation for all prescription orders.Practice first call resolution to help health care providers and patients with their pharmacy needs.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 CPR+ system including patient demographic and insurance information.Perform full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources.Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement.Document outcomes of benefits review in CPR+ system for 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.Contribute to team effort by accomplishing related tasks as needed and other duties as assigned.Conduct job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, and applicable laws.Education/Learning ExperienceRequired: 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 ExperienceRequired: 1+ years pharmacy or benefit verification experience.Desired: 3+ years pharmacy or benefit verification experience.Skills/KnowledgeRequired: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge 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.Licenses/CertificationsRequired: Registration with Board of Pharmacy as required by state law.Desired: Certified Pharmacy Technician (PTCB).Other RequirementsIndependent 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.
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