Pharmacy Benefit Verification Specialist

Onco360•Denver, CO

28d•Hybrid

About The Position

Onco360, a closed-door specialty pharmacy focused on patients undergoing cancer treatment, is seeking a Pharmacy Benefit Verification Specialist to support patients, healthcare providers, and pharmacy operations. This full-time remote/hybrid opportunity works in the Mountain Time Zone, with shifts running from 10 a.m. to 8 p.m. Mountain Time. Applicants must have active Colorado Pharmacy Technician credentials from the State Board of Pharmacy. The specialist investigates, reviews, and loads patient medical and pharmacy insurance information; coordinates benefits; runs test claims to obtain valid insurance responses and determine reimbursement; identifies authorization requirements; and enrolls eligible patients in copay card assistance programs. The role is responsible for accurate benefit documentation for prescription orders and complete patient setup in the CPR+ system. The position also supports first-call resolution, responds to benefit inquiries, facilitates requests for medical authorizations and related documentation, and follows pharmacy procedures, professional standards, confidentiality requirements, and applicable laws. The posted starting salary is $25 per hour and up. A $5,000 sign-on bonus is available for employees who start before December 31, 2026, and quarterly incentive bonuses are offered.

Requirements

Active Colorado Pharmacy Technician credentials from the State Board of Pharmacy.
High school diploma or GED.
At least 1 year of pharmacy or benefit verification experience.
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 medication brand and generic 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.
Three or more 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.
Ensure complete and accurate patient setup in the CPR+ system, including demographic and insurance information.
Perform full pharmacy and/or medical benefit verification 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 a valid claim response 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.
Complete related tasks and other duties as assigned.
Conduct job responsibilities in accordance with the company Code of Business Conduct and Ethics, policies and procedures, Corporate Compliance Agreement, applicable federal and state laws, and professional standards.