Onco360 Oncology Pharmacy
Pharmacy Benefits Verification Specialist
Onco360 Oncology Pharmacy, Houston, Texas, United States, 77246
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Pharmacy Benefits Verification Specialist
role at
Onco360 Oncology Pharmacy .
Onco360 Pharmacy is looking for Pharmacy Benefit Verification Specialists for our Pharmacy located in Houston, TX.
Work Hours:
Monday‑Friday shifts available; some weekends as needed.
Starting Salary:
$24.00/hr and up. We also offer quarterly incentive bonuses.
Sign‑On Bonus:
$5,000 for employees starting before January 31, 2026.
Benefits
Medical, Dental & Vision insurance
401(k) with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Paid Volunteer Day
Floating Holiday
Referral Incentive
Paid Life, and short & long‑term disability insurance
Pharmacy Benefit Verification Summary The Benefit 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, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs. They will ensure accurate benefit documentation is made for all prescription orders.
Major Responsibilities
Practice first call resolution to help health care 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 patient demographic and insurance information.
Perform 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.
Contribute to team effort by accomplishing related tasks as needed and other duties as assigned.
Conduct 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.
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 from a 2‑year program or technical school, 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, 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, Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
Behavior Competencies
Required: Independent worker, good interpersonal skills, excellent verbal and written communication skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail‑oriented, great time‑management skill.
#Company Values: Teamwork, Respect, Integrity, Passion
#J-18808-Ljbffr
Pharmacy Benefits Verification Specialist
role at
Onco360 Oncology Pharmacy .
Onco360 Pharmacy is looking for Pharmacy Benefit Verification Specialists for our Pharmacy located in Houston, TX.
Work Hours:
Monday‑Friday shifts available; some weekends as needed.
Starting Salary:
$24.00/hr and up. We also offer quarterly incentive bonuses.
Sign‑On Bonus:
$5,000 for employees starting before January 31, 2026.
Benefits
Medical, Dental & Vision insurance
401(k) with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Paid Volunteer Day
Floating Holiday
Referral Incentive
Paid Life, and short & long‑term disability insurance
Pharmacy Benefit Verification Summary The Benefit 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, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs. They will ensure accurate benefit documentation is made for all prescription orders.
Major Responsibilities
Practice first call resolution to help health care 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 patient demographic and insurance information.
Perform 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.
Contribute to team effort by accomplishing related tasks as needed and other duties as assigned.
Conduct 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.
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 from a 2‑year program or technical school, 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, 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, Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
Behavior Competencies
Required: Independent worker, good interpersonal skills, excellent verbal and written communication skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail‑oriented, great time‑management skill.
#Company Values: Teamwork, Respect, Integrity, Passion
#J-18808-Ljbffr