Pharmacy Benefit Verification Specialist

Onco360•Columbus, OH

10d•Remote

About The Position

Onco360 Pharmacy is seeking Pharmacy Benefit Verification Specialists for its specialty oncology pharmacy. This full-time position may be performed remotely and requires active Ohio Pharmacy Technician credentials from the State Board of Pharmacy. Shift times fall between 8 a.m. and 8 p.m. Starting pay is $24 per hour and up. The position also offers a $5,000 sign-on bonus for employees who start before December 31, 2026, and quarterly incentive bonuses. The specialist investigates, reviews, and loads patient medical and pharmacy insurance information; coordinates benefits; runs test claims to obtain valid responses; identifies authorization requirements; and enrolls eligible patients in copay card assistance programs. The specialist documents benefits accurately for prescription orders and supports patients, healthcare providers, and pharmacy operations. Onco360 is a closed-door specialty pharmacy serving patients undergoing cancer treatment.

Requirements

High school diploma or GED.
Previous experience in pharmacy, medical billing, or benefits verification.
At least 1 year of pharmacy or benefit verification experience.
Pharmacy Technician License/Registration with the Board of Pharmacy, as required by state law; the posting specifically requires active Ohio Pharmacy Technician credentials from the State Board of Pharmacy.
Knowledge of pharmacy insurance and benefit verification, PBM and medical contracts, Medicare, Medicaid, commercial insurance, 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 brand and generic medication names.
Basic math and analytical skills and intermediate typing/keyboarding skills.
Ability to work independently, meet deadlines efficiently, and remain flexible; interpersonal skills, excellent verbal and written communication, attention to detail, and strong time management.

Nice To Haves

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

Responsibilities

Practice first-call resolution by assisting 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.
Ensure complete and accurate patient setup 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 other applicable insurance coverage to patient profiles.
Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement; document benefits review outcomes in CPR+ 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 laws, and professional standards.