Pharmacy Benefit Verification Specialist

Onco360•Orlando, FL

23h•Remote

About The Position

Onco360 Pharmacy is hiring Pharmacy Benefit Verification Specialists for its specialty oncology pharmacy. The role investigates, reviews, and loads accurate patient medical and pharmacy insurance coverage; coordinates benefits; runs test claims to obtain valid responses for medications; identifies authorization requirements; and enrolls eligible patients in copay card assistance programs. Specialists ensure benefit information is accurately documented for each prescription order and support patients and healthcare providers with pharmacy needs. The role may be performed remotely and requires active Florida Pharmacy Technician credentials. Shift times fall between 8 a.m. and 8 p.m. Compensation starts at $24 per hour, with a $5,000 sign-on bonus for employees who start before December 31, 2026, and quarterly incentive bonuses. Onco360 is a closed-door specialty pharmacy focused on patients undergoing cancer treatment. The company seeks team members who are passionate about helping patients and meeting their needs.

Requirements

High school diploma or GED.
At least 1 year of pharmacy or benefit verification experience.
Active Pharmacy Technician license or registration with the Board of Pharmacy, as required by state law; this posting specifically requires active Florida Pharmacy Technician credentials.
Knowledge of pharmacy insurance and benefit verification, PBM and medical contracts, Medicare, Medicaid, and commercial insurance.
Knowledge of pharmacy test claims, NCPDP claim rejection resolution, coordination of benefits, and NDC medication billing.
Pharmacy or healthcare-related knowledge, including pharmacy terminology such as sig codes and Roman numerals, and medication brand and generic names.
Basic math and analytical skills and intermediate typing/keyboarding skills.
Ability to work independently, communicate effectively verbally and in writing, meet deadlines efficiently, and remain flexible.
Interpersonal skills, attention to detail, and strong time-management skills.

Nice To Haves

Previous experience in pharmacy, medical billing, or benefits verification.
Associate degree or equivalent program from a two-year program or technical school.
Certified Pharmacy Technician (PTCB) certification.
Specialty pharmacy experience.
At least 3 years of pharmacy or benefit verification experience.

Responsibilities

Practice first-call resolution by helping healthcare providers and patients with pharmacy needs and answering questions and requests.
Provide thorough, accurate, and timely responses to pharmacy operations, providers, and patients regarding benefit information.
Set up patients accurately in the CPR+ system, including demographic and insurance information.
Verify pharmacy and medical benefits using electronic resources and E1 check, and load primary, secondary, tertiary, and medical insurances to patient profiles.
Run test claims at each licensed pharmacy site to obtain valid claim responses and determine optimal reimbursement.
Document benefit review outcomes in the CPR+ system for pharmacy operations and ensure orders are assigned to the appropriate dispensing pharmacy.
Facilitate requests for medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, Medicare, or facility medication claims.
Maintain a safe and clean pharmacy by following procedures, rules, regulations, and professional practice and patient confidentiality laws.
Contribute to team efforts by completing related tasks and other assigned duties.
Perform responsibilities in accordance with the Company's Code of Business Conduct and Ethics, policies and procedures, Corporate Compliance Agreement, applicable federal and state laws, and professional standards.