Pharmacy Benefit Verification Supervisor

Onco360 • Houston, TX

6d • Hybrid

About The Position

The Pharmacy Benefit Verification Supervisor is responsible for oversight of activities relating to the proper loading and investigation of patient prescription benefits, including but not limited to patient demographics, medical and pharmacy coverage, and investigation/identification of authorization requirements needed to obtain medication coverage. This role requires advanced program knowledge and will provide quality control by routinely examining cases completed by team members.

Requirements

• High School Diploma or GED
• Previous Experience in Pharmacy, Medical Billing, or Benefits Verification
• 4+ years pharmacy or benefit verification experience
• Previous leadership experience
• Pharmacy insurance and benefit verification
• PBM and Medical contracts
• knowledge/understanding of Medicare, Medicaid, and commercial insurance
• pharmacy test claim and NCPDP claim rejection resolution
• coordination of benefits
• NDC medication billing
• excellent interpersonal skills
• able to work with all levels of management and staff
• vast knowledge of pharmacy terminology and process including sig codes, and roman numerals, brand/generic names of medication
• advanced typing, math and analytical skills
• leadership skills
• Registration with Board of Pharmacy as required by state law
• 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
• leadership

Nice To Haves

• Associates or Bachelor’s Degree
• Certified Pharmacy Technician (PTCB)
• Specialty pharmacy experience
• 5+ years pharmacy or benefit verification experience
• 1+ years supervisor experience
• Specialty pharmacy experience
• Specialty pharmacy operations
• independent decision-making abilities
• able to conduct research, be resourceful, and self-reliant
• excellent communication skills
• Certified Pharmacy Technician (PTCB)
• Advanced Certified Pharmacy Technician with completion of Billing and Reimbursement certification

Responsibilities

• Supervises BV/onboarding staff in a leadership role to maintain a positive working environment by creating synergy and teamwork to minimize employee relations issues and reduce turnover. Communicates effectively across pharmacy and/or corporate teams and with patients, and successfully resolves issues.
• Assists manager in day-to-day pharmacy operations and in implementing new procedures to ensure that the accurate and timely dispensing of quality pharmacy services is consistently delivered to all patients using effective service leadership and customer skills.
• Works with pharmacy management to recruit, select, hire, orientate, develop, and train new associates. On an ongoing basis, evaluates, coaches, and utilizes performance management practices to motivate and set expectations for BV staff. In collaboration with management, drafts and delivers effective corrective action plans and disciplinary action to technicians performing at substandard levels.
• Manages and reports on daily activity of vertical team members, including monitoring of daily workflow and Pulse reporting.
• Manage patient authorizations specific to Threshold Override Authorizations (TOA), SNF Letters of Agreement (LOA), and the like.
• Monitors and escalates No-Go trends or contract-related claim rejections to Patient Benefits Manager
• Provides ongoing access and training on web tools to the BV/Onboarding team and offers frontline support to address system functionality questions and issues (Ex: provider eligibility portals, copay card portals, applications, etc.)
• Communicate to Pharmacy personnel payor benefit programs and policies and ensure all payer types are handled correctly by the team.
• Handles escalations for difficult BV cases/questions to ensure accurate and timely completion of BV
• Works with Pharmacy Technician Manager and/or Director of Pharmacy Operations on other responsibilities, projects, implementations, and initiatives as needed.
• Maintains a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
• Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.

Benefits

• Medical
• Dental
• Vision
• 401k with a match
• Paid Time Off
• Paid Holidays
• Tuition Reimbursement
• Quarterly Incentive Bonus
• Paid Volunteer Day
• Company paid benefits – life insurance; and short and long-term disability

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED