Benefit Verification Technician

American Oncology Network•Fort Myers, FL

2d•Remote

About The Position

The Benefit Verification Technician is responsible for verifying insurance coverages for private, Medicaid, Medicare, VA, IHS, and other unique programs. This role involves completing patient facility verifications, determining medication coverage, and ensuring patient eligibility to utilize AON Pharmacy. The technician will also offer and enroll patients in manufacturer copay cards, determine network coverage for specialty medications, and manage prescription referrals to outside pharmacies. Additionally, the role involves resolving claim issues, communicating effectively with internal and external customers, and ensuring compliance with all relevant guidelines and policies.

Requirements

High school education, GED, or equivalent required.
Active/Unrestrictive Pharmacy Technician permit in the state of residence.
Willing to obtain Florida Technician permit (if applicable).
Two years’ experience in specialty, retail, mail order, or hospital pharmacy as a pharmacy technician is required.
Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills.
Must be detail oriented with the ability to exercise independent judgment.
Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness.
Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters.
Good command of the English language.
Effective communication skills (oral, written, presentation), is an active listener, and effectively provides balanced feedback.
Strong customer focus.
Ability to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as positive employee, physician and community relations.
Effectively manages own time, conflicting priorities, self, stress, and professional development.
Self-motivated and self-starter with ability to work independently with limited supervision.
Ability to work remotely effectively as required.
Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites.
Proficiency in MS Office Word, Excel, Power Point, and Outlook required.

Nice To Haves

Second language is an asset but not required.

Responsibilities

Verify Private, Medicaid, and Medicare insurance coverages (include VA, IHS, and other unique programs).
Complete patient facility (Hospital, Hospice, Rehab, ALF, Skilled Nursing, etc.) verifications and determine medication coverage.
Verify patient eligibility to utilize AON Pharmacy via test claim to their pharmacy insurance.
Refer prescriptions to Prior Authorization or Financial Assistance teams based on test claim responses.
Offer and enroll patients in manufacturer copay cards for commercial payors.
Determine network coverage for specialty oncology and hematology medications.
Determine which pharmacy can dispense on behalf of the patient.
Inform patients of prescription referral to outside pharmacies and notify nursing staff to forward prescription.
Document prescription referrals in the EMR system.
Obtain Limited Distribution Overrides for AON Pharmacy to fill.
Understand claim responses regarding patient plan structure and educate patients regarding financial responsibility.
Resolve COB coverage issues with patients and payor to correctly adjudicate claims.
Resolve claim submission issues with outside dispensing pharmacies.
Ensure effective communication and premier customer service with all internal and external customers.
Actively listen and understand patient questions and provide accurate answers and solutions.
Address all phone calls professionally, courteously and in a timely manner.
Act as a liaison between teams to communicate changes and improve interdepartmental processes.
Review incoming team emails to verify they are answered in a timely and professional manner.
Ensure all local, state, and federal guidelines are followed as well as corporate policies, pharmacy Standard Operating Procedures (SOPs) and accreditation bureaus’ standards.
Verify all department compliance training is completed by the established deadlines.
Maintain continuing education requirements for licensure.
Maintain and ensure the confidentiality of all patient and employee information as required by the HIPAA regulations.
Assist department management in ensuring the storage, collection, and destruction of all Protected Healthcare Information is adherent to all federal and state guidelines, in addition to all accreditation standards.
Perform other duties and projects as assigned.