Medical Benefits Verification Supervisor

Onco360•Louisville, KY

10d•Onsite

About The Position

Onco360 Pharmacy is seeking a Medical Benefits Verification Supervisor for their Pharmacy located in Louisville, KY. This role is responsible for supporting Medical Benefits Verification Specialists in performing insurance authorization and verification for patients scheduled for services. The Supervisor will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and identify authorization requirements for medication coverage.

Requirements

High School Diploma or GED
Previous Experience in Pharmacy, Medical Billing, or Benefits Verification
3+ years’ Medicare and Medical benefit verification experience
Previous leadership experience
Medicare and Medical insurance and benefit verification
Medical contracts
Knowledge/understanding of Medicare, Medicaid, and commercial insurance
Coordination of benefits
Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines
NDC medication billing
Pharmacy or healthcare-related knowledge
Knowledge of pharmacy terminology including sig codes
Basic math and analytical skills
Intermediate typing/keyboarding skills
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

Nice To Haves

Associate degree or equivalent program from a 2-year program or technical school
Certified Pharmacy Technician (PTCB)
Specialty pharmacy experience
5+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience
1+ years supervisor experience
Specialty Pharmacy experience
Medicare Billing Experience
Medical Authorization experience
Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB)

Responsibilities

Support staff in verifying Commercial and Government payer eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contacting Medicare or other relevant government payers to confirm coverage and benefits for specific services.
Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. Confirming patient eligibility and benefits with various commercial insurance carriers (i.e. Aetna, Humana, Anthem, Cigna, etc.).
Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information and patient copays, deductibles and Out-of-Network responsibilities.
Facilitate process for requesting medical authorizations, Single Case Agreements, Letter of Agreements, and Terms of Agreement for applicable commercial, Medicaid, and Medicare, or facility medication claims.
Investigate payer plans: Research and document benefit plan specifics for various payer plans, including cost-share responsibilities and restrictions.
Develop expertise: Maintain in-depth knowledge of insurance policies, coverage terms, and complex billing practices. Identify the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements for approval.
Handle complex cases: Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.
Collaborate across departments: Work closely with clinical staff, billing and coding teams, and administrative teams to resolve insurance issues and ensure seamless patient care. Will be the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated.