Pharmacy Benefit Verification Specialist

4 days ago

Woodridge, Illinois, United States Onco360 Full time
Pharmacy Benefit Verification Specialist Job Description

At Onco360 Pharmacy, we are seeking a highly skilled Pharmacy Benefit Verification Specialist to join our team. As a Pharmacy Benefit Verification Specialist, you will play a critical role in ensuring accurate patient insurance information and benefit verification. Your primary responsibilities will include investigating, reviewing, and loading accurate patient insurances, including medical and pharmacy coverage, assigning coordination of benefits, running test claims to obtain a valid insurance response on patient medications, and enrolling eligible patients in copay card assistance programs.

Key Responsibilities:
  • Practices first call resolution to help healthcare 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.

Requirements:
  • Education/Learning Experience: High School Diploma or GED, Previous Experience in Pharmacy, Medical Billing, or Benefits Verification.
  • Work Experience: 1+ years pharmacy or benefit verification experience.
  • Skills/Knowledge: 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.
  • Licenses/Certifications: Registration with Board of Pharmacy as required by state law.
  • Behavior Competencies: 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.

Company Values: Teamwork, Respect, Integrity, Passion

  • Pharmacy Adjudication Specialist

    4 weeks ago

    Woodridge, Illinois, United States Onco360 Full time

    Job Title: Pharmacy Adjudication SpecialistAt Onco360, we are seeking a highly skilled Pharmacy Adjudication Specialist to join our team. As a Pharmacy Adjudication Specialist, you will play a critical role in ensuring the accurate and timely adjudication of pharmacy claims.Key Responsibilities:Adjudicate pharmacy claims for prescriptions in active workflow...

  • Pharmacy Claims Adjudication Specialist

    2 weeks ago

    Woodridge, Illinois, United States Onco360 Full time

    Pharmacy Adjudication SpecialistWe are seeking a highly skilled Pharmacy Adjudication Specialist to join our team at Onco360 Pharmacy. As a Pharmacy Adjudication Specialist, you will be responsible for adjudicating pharmacy claims, reviewing claim responses for accuracy, and ensuring prescription claims are adjudicated correctly according to the coordination...

  • Pharmacy Claims Specialist

    1 month ago

    Woodridge, Illinois, United States Onco360 Full time

    Pharmacy Adjudication SpecialistWe are seeking a highly skilled Pharmacy Adjudication Specialist to join our team at Onco360 Pharmacy in Woodridge, IL. This is a full-time position with two available shifts: Monday to Friday, 10:30am to 7pm CST or 8:30am to 5pm CST. The ideal candidate will be located within driving distance to our pharmacy and have a hybrid...

  • Pharmacy Claims Specialist

    2 weeks ago

    Woodridge, Illinois, United States Onco360 Full time

    Job Title: Pharmacy Adjudication SpecialistWe are seeking a highly skilled Pharmacy Adjudication Specialist to join our team at Onco360 Pharmacy in Woodridge, IL. This is a full-time position, Monday to Friday, 10:30am to 7pm CST.Job Summary:The Pharmacy Adjudication Specialist will be responsible for adjudicating pharmacy claims, reviewing claim responses...

  • Pharmacy Claims Adjudication Specialist

    5 days ago

    Woodridge, Illinois, United States Onco360 Full time

    About the Role:We are seeking a highly skilled Pharmacy Adjudication Specialist to join our team at Onco360 Pharmacy. As a Pharmacy Adjudication Specialist, you will be responsible for adjudicating pharmacy claims, reviewing claim responses for accuracy, and ensuring prescription claims are adjudicated correctly according to the coordination of benefits.Key...

  • Pharmacy Prior Authorization Specialist

    1 month ago

    Woodridge, Illinois, United States Onco360 Full time

    Pharmacy Prior Authorization SpecialistWe are seeking a highly skilled Pharmacy Prior Authorization Specialist to join our team at Onco360 Pharmacy. As a Pharmacy Prior Authorization Specialist, you will play a critical role in ensuring that patients receive the medication they need by navigating the complex prior authorization process.Key...

  • Pharmacy Prior Authorization Specialist

    1 week ago

    Woodridge, Illinois, United States Onco360 Full time

    Pharmacy Prior Authorization SpecialistWe are seeking a highly skilled Pharmacy Prior Authorization Specialist to join our team at Onco360 Pharmacy. As a Pharmacy Prior Authorization Specialist, you will play a critical role in ensuring that patients receive the medication they need by managing prior authorizations with insurance carriers.Key...

  • Pharmacy Technician

    2 weeks ago

    Woodridge, Illinois, United States Onco360 Full time

    Job Title: Pharmacy Technician - Data Entry SpecialistOnco360 is seeking a highly skilled Pharmacy Technician to join our team in Woodridge, IL. As a Data Entry Specialist, you will be responsible for creating patient profiles and processing orders in a timely manner from electronic prescription and fax queues.Key Responsibilities:Request refill...

  • Pharmacy Prior Authorization Specialist

    5 days ago

    Woodridge, Illinois, United States Onco360 Full time

    We are seeking a highly skilled Pharmacy Prior Authorization Specialist to join our team at Onco360 Pharmacy. The ideal candidate will have excellent communication skills, be detail-oriented, and have a strong understanding of pharmacy insurance claims and prior authorization processes.The Pharmacy Prior Authorization Specialist will be responsible for...

  • Pharmacy Director

    2 weeks ago

    Woodridge, Illinois, United States Walgreens Full time

    Job SummaryAs a Pharmacy Director at Walgreens, you will be responsible for directing the operation of a Local Specialty Pharmacy and accountable for improving unit sales, profits, and image through the overall development and protection of store assets, the selection, training, and development of personnel, and proper service to customers.Key...

  • Pharmacy Technician Specialist

    2 weeks ago

    Woodridge, Illinois, United States BrightSpring Health Services Full time

    About the RoleWe are seeking a highly skilled Pharmacy Technician to join our team at BrightSpring Health Services. As a Pharmacy Technician, you will play a critical role in ensuring the smooth operation of our pharmacy services.Key ResponsibilitiesCoordinate and schedule the preparation of IV therapies and home medical equipment orders under the...

  • Lead Pharmacy Billing Team Manager

    4 days ago

    Woodridge, Illinois, United States Symbria Full time

    Job Title: Lead Pharmacy Billing Team ManagerSymbria Rx Services is seeking a highly skilled and experienced Lead Pharmacy Billing Team Manager to join our team.The successful candidate will be responsible for overseeing the daily operations of our pharmacy billing team, ensuring timely and accurate billing processes, and providing guidance and support to...

  • Pharmacy Technician

    5 days ago

    Woodridge, Illinois, United States Onco360 Full time

    We are seeking a skilled Pharmacy Technician to join our Specialty Pharmacy team at Onco360. As a Pharmacy Technician, you will play a vital role in supporting our patients and healthcare providers by phone, answering questions and requests.Key responsibilities include communicating with patients and physician office staff to coordinate medication refill...

  • Pharmacy Technician

    2 weeks ago

    Woodridge, Illinois, United States Walgreens Full time

    Job SummaryAs a Pharmacy Technician at Walgreens, you will play a vital role in providing exceptional customer service and supporting the pharmacy team in delivering high-quality patient care. You will assist pharmacists in the practice of pharmacy, including retrieving, counting, and pouring pharmaceutical drugs, verifying medicine, and checking for...

  • Lead Pharmacy Billing Team Manager

    4 days ago

    Woodridge, Illinois, United States Symbria Full time

    Job SummarySymbria is seeking a highly skilled Lead Pharmacy Billing Technician to oversee daily operations of an assigned billing team. This key role involves developing a thorough understanding of skilled nursing admission processes and required documentation to guide the team's efforts in executing timely billing.The ideal candidate will have a strong...

  • Third-Party Audit Specialist

    1 week ago

    Woodridge, Illinois, United States Symbria Full time

    Job SummarySymbria Rx Services is seeking a highly skilled Third-Party Audit Specialist to join our team. As a key member of our team, you will be responsible for the timely and accurate completion of third-party audits.ResponsibilitiesComplete third-party audits in a timely and accurate mannerServe as the primary point of contact for third-party...

  • Lead Pharmacy Billing Team Manager

    2 weeks ago

    Woodridge, Illinois, United States Symbria Full time

    Job Title: Lead Pharmacy Billing TechnicianSymbria Rx Services is seeking a highly skilled and experienced Lead Pharmacy Billing Technician to join our team.Job Summary:The Lead Pharmacy Billing Technician will be responsible for overseeing the daily operations of an assigned team of billers, ensuring timely and accurate billing processes, and providing...

  • Pharmacy Technician

    4 days ago

    Woodridge, Illinois, United States Symbria Full time

    Job Summary:Symbria Rx Services is seeking a skilled Pharmacy Technician to join our team at our Pharmacy located in Woodridge, IL. As a Pharmacy Technician, you will assist the pharmacist in the preparation of medications for distribution to Long-Term Care (LTC) communities.Key Responsibilities:Assist the pharmacist(s) on duty in preparing medications for...

  • Pharmacy Technician

    4 days ago

    Woodridge, Illinois, United States Symbria Full time

    Job Summary:Symbria Rx Services is seeking a highly skilled Pharmacy Technician to join our team at our Pharmacy located in Woodridge, IL. As a Pharmacy Technician, you will play a crucial role in assisting pharmacists in the preparation of medications for distribution to Long-Term Care (LTC) communities.Key Responsibilities:Assist pharmacists on duty in...

  • Pharmacy Technician

    4 days ago

    Woodridge, Illinois, United States Symbria Full time

    Job SummarySymbria is seeking a highly skilled Pharmacy Technician to join our team at our pharmacy located in Woodridge, IL. As a Pharmacy Technician, you will play a crucial role in assisting pharmacists in the preparation of medications for distribution to Long-Term Care (LTC) communities.Key Responsibilities:Assist pharmacists in filling orders...