Pharmacy Benefit Verification Specialist

Onco360•Columbus, OH

14d•Remote

About The Position

Onco360 Pharmacy is hiring a full-time Pharmacy Benefit Verification Specialist for its closed-door specialty oncology pharmacy. The role may be performed remotely, but candidates must have 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, with a $5,000 sign-on bonus for employees who start before December 31, 2026, and quarterly incentive bonuses. The specialist investigates, reviews, documents, and loads patient medical and pharmacy insurance coverage; coordinates benefits; runs test claims; identifies authorization requirements; and enrolls eligible patients in copay assistance programs. The role supports patients, providers, and pharmacy operations with accurate and timely benefit information, while ensuring patient profiles and prescription orders are set up and routed appropriately. The specialist must protect patient confidentiality and comply with company policies, professional standards, and applicable laws.

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 position specifically requires active Ohio Pharmacy Technician credentials from the State Board of Pharmacy.
Knowledge of pharmacy insurance and benefit verification, PBM and medical contracts, and 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 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.
Good interpersonal skills and excellent verbal and written communication 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).
Specialty pharmacy experience.
At least 3 years of pharmacy or benefit verification experience.

Responsibilities

Resolve inquiries from healthcare providers and patients about pharmacy needs, questions, and requests on first contact when possible.
Provide thorough, accurate, and timely benefit information to pharmacy operations, providers, and patients.
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 other applicable insurance coverage 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 CPR+ for pharmacy operations and ensure orders are assigned to the appropriate dispensing pharmacy.
Facilitate requests for medical authorizations, letters of agreement (LOAs), and terms of agreement (TOAs) for applicable commercial, Medicaid, Medicare, or facility medication claims.
Enroll eligible patients in copay card assistance programs.
Maintain a safe and clean pharmacy in compliance with procedures, rules, regulations, and patient confidentiality laws.
Complete related tasks and other duties as assigned.
Perform job 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.