Benefit Verification Specialist - BioPlus Specialty Pharmacy
About The Position
BioPlus Specialty Pharmacy, a proud member of the Elevance Health family of companies, is seeking a Benefit Verification Specialist. This role is responsible for accurately reviewing, verifying, and documenting patient insurance coverage for both medical and pharmacy benefits. This includes loading insurance details, coordinating benefits, and running test claims to confirm coverage and reimbursement outcomes. The specialist will communicate with insurance providers, healthcare teams, and patients to gather and confirm benefit information such as coverage, copays, deductibles, and authorization requirements. They will also support prior authorizations, appeals, and enrollment in financial assistance programs. Key tasks include ensuring accurate patient setup in the system, monitoring referrals, submitting and following up on authorization requests, and documenting all findings. The specialist will inform patients about their coverage status, financial obligations, and next steps, aiming for first-call resolution while maintaining compliance with regulations and patient confidentiality. Collaboration with pharmacy teams and providers is essential to ensure timely medication access and proper claim processing.
Requirements
- HS Diploma or GED
- 1 year of pharmacy or insurance verification experience
Nice To Haves
- Pharmacy Tech license or certification highly desired.
- Specialty Pharmacy experience preferred.
- Pharmacy and Medical claim research experience preferred.
- Copay card and/or manufacturing experience preferred.
- Call center experience preferred.
- General knowledge of company pharmacy services, products, insurance benefits, contracts, and claims preferred.
- Experience with Medicare (Parts A–D) and specialty pharmacy is preferred.
Responsibilities
- Accurately review, verify, and document patient insurance coverage for both medical and pharmacy benefits.
- Load insurance details, coordinate benefits, and run test claims to confirm coverage and reimbursement outcomes.
- Communicate with insurance providers, healthcare teams, and patients to gather and confirm benefit information such as coverage, copays, deductibles, and authorization requirements.
- Support prior authorizations, appeals, and enrollment in financial assistance programs.
- Ensure accurate patient setup in the system.
- Monitor referrals, submit, and follow up on authorization requests.
- Document all findings for operational use.
- Inform the patient regarding their coverage status, financial obligations, and next steps.
- Resolve inquiries efficiently, aiming for first-call resolution, while maintaining compliance with regulations and patient confidentiality standards.
- Collaborate with pharmacy teams and providers to ensure timely medication access and proper claim processing.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs (unless covered by a collective bargaining agreement)
- Medical
- Dental
- Vision
- Short and long term disability benefits
- 401(k) +match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
