Onco360 Oncology Pharmacy
Pharmacy Benefits Verification Specialist
Onco360 Oncology Pharmacy, Louisville, Kentucky, us, 40201
Pharmacy Benefits Verification Specialist
Onco360 Oncology Pharmacy – Louisville, KY
Work Hours Monday–Friday shifts available; some weekends as needed.
Compensation Starting at $22/hr plus quarterly incentive bonuses. Sign‑On Bonus: $5,000 for employees starting before January 31, 2026.
Benefits
Medical, Dental & Vision insurance
401k with match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Paid Volunteer Day
Floating Holiday
Referral Incentive
Paid Life and short & long‑term disability insurance
Job Summary The Pharmacy Benefits Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, identify authorization requirements, and enroll eligible patients in copay card assistance programs. Accurate benefit documentation will be maintained for all prescription orders.
Major Responsibilities
Practice first‑call resolution to help healthcare providers and patients with their pharmacy needs, answering questions and requests.
Provide thorough, accurate, and timely responses to requests from pharmacy operations, providers, and/or patients regarding benefit information.
Ensure complete and accurate patient setup in CPR+ system, including demographic and insurance information.
Perform full benefits verification on patients for pharmacy and/or medical benefits using electronic resources and E1 check, loading primary, secondary, tertiary, etc. insurances to the patient profile.
Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement; document outcome in CPR+ system for operations and disposition 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 complying with procedures, rules, regulations, and professional practice and patient confidentiality laws.
Contribute to team effort by accomplishing related tasks as needed and other duties as assigned.
Act in accordance with the Company’s Code of Business Conduct and Ethics, policies, procedures, and applicable federal and state laws.
Qualifications
Education/Learning Experience
Required: High School Diploma or GED. Previous experience in pharmacy, medical billing, or benefits verification.
Desired: Associate degree or equivalent program, Certified Pharmacy Technician (PTCB), specialty pharmacy experience.
Work Experience
Required: 1+ years pharmacy or benefit verification experience.
Desired: 3+ years pharmacy or benefit verification experience.
Skills/Knowledge
Required: Pharmacy insurance and benefit verification, PBM and medical contracts, 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, pharmacy terminology (sig codes, Roman numerals, brand/generic names), basic math and analytical skills, intermediate typing/keyboarding skills.
Behavior Competencies
Required: Independent worker, good interpersonal skills, excellent verbal and written communication, ability to work efficiently to meet deadlines, detail‑oriented, great time‑management skills.
Company Values Teamwork, Respect, Integrity, Passion
Contact and Application Referrals increase your chances of interviewing at Onco360 Oncology Pharmacy by 2x. Get notified about new Pharmacy Specialist jobs in Louisville, KY.
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Work Hours Monday–Friday shifts available; some weekends as needed.
Compensation Starting at $22/hr plus quarterly incentive bonuses. Sign‑On Bonus: $5,000 for employees starting before January 31, 2026.
Benefits
Medical, Dental & Vision insurance
401k with match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Paid Volunteer Day
Floating Holiday
Referral Incentive
Paid Life and short & long‑term disability insurance
Job Summary The Pharmacy Benefits Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, identify authorization requirements, and enroll eligible patients in copay card assistance programs. Accurate benefit documentation will be maintained for all prescription orders.
Major Responsibilities
Practice first‑call resolution to help healthcare providers and patients with their pharmacy needs, answering questions and requests.
Provide thorough, accurate, and timely responses to requests from pharmacy operations, providers, and/or patients regarding benefit information.
Ensure complete and accurate patient setup in CPR+ system, including demographic and insurance information.
Perform full benefits verification on patients for pharmacy and/or medical benefits using electronic resources and E1 check, loading primary, secondary, tertiary, etc. insurances to the patient profile.
Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement; document outcome in CPR+ system for operations and disposition 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 complying with procedures, rules, regulations, and professional practice and patient confidentiality laws.
Contribute to team effort by accomplishing related tasks as needed and other duties as assigned.
Act in accordance with the Company’s Code of Business Conduct and Ethics, policies, procedures, and applicable federal and state laws.
Qualifications
Education/Learning Experience
Required: High School Diploma or GED. Previous experience in pharmacy, medical billing, or benefits verification.
Desired: Associate degree or equivalent program, Certified Pharmacy Technician (PTCB), specialty pharmacy experience.
Work Experience
Required: 1+ years pharmacy or benefit verification experience.
Desired: 3+ years pharmacy or benefit verification experience.
Skills/Knowledge
Required: Pharmacy insurance and benefit verification, PBM and medical contracts, 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, pharmacy terminology (sig codes, Roman numerals, brand/generic names), basic math and analytical skills, intermediate typing/keyboarding skills.
Behavior Competencies
Required: Independent worker, good interpersonal skills, excellent verbal and written communication, ability to work efficiently to meet deadlines, detail‑oriented, great time‑management skills.
Company Values Teamwork, Respect, Integrity, Passion
Contact and Application Referrals increase your chances of interviewing at Onco360 Oncology Pharmacy by 2x. Get notified about new Pharmacy Specialist jobs in Louisville, KY.
#J-18808-Ljbffr