Senior Pharmacy Benefit Verification Specialist

Onco360 • New Hyde Park, NY

10d • Onsite

About The Position

Onco360 Pharmacy is seeking a Senior Pharmacy Benefit Verification Specialist for its location in New Hyde Park, NY. Onco360 Pharmacy is a unique oncology pharmacy model designed to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. The available shift is 10:30 am - 7:00 pm EST. The starting salary is $30/HR and up.

Requirements

• High School Diploma or GED
• Previous Experience in Pharmacy, Medical Billing, or Benefits Verification
• 2+ years pharmacy or benefit verification 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
• pharmacy or healthcare-related knowledge
• knowledge of pharmacy terminology including sig codes, and Roman numerals
• brand/generic names of medication
• basic math and analytical skills
• Intermediate typing/keyboarding 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

Nice To Haves

• Associates or Bachelor’s Degree
• Certified Pharmacy Technician (PTCB)
• Specialty pharmacy experience
• 3+ years pharmacy or benefit verification experience
• Specialty pharmacy experience
• leadership skills

Responsibilities

• Works and resolve difficult or escalated cases to assist in processing prescription orders
• Participates in the orientation and training of benefit verification specialists within workflow vertical
• Escalates workflow/process improvement ideas to leadership
• Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests
• Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information
• Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information
• Performs full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profile
• Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement, then document outcome of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy
• Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims
• Maintain 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
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Benefits

• Medical
• Dental
• Vision
• 401k with a match
• Paid Time Off
• Paid Holidays
• Tuition Reimbursement
• Company paid benefits – life
• short and long-term disability

What This Job Offers

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