pharmacy benefits coordinator

Medical Mutual

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   We are seeking candidates who are currently based in Ohio for this role.
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 Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
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  Medicare Pharmacy Coordinator I
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   Job Summary:
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 Working under general supervision, administers typically more standardized or routine daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part C (medical drug) benefit programs. Configures, implements, maintains, and services Medicare and Individual pharmacy benefits, with a strong focus on member experience.
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   Responsibilities:
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   Coordinates pharmacy reject review and resolution either directly or forwards/escalates to other departments or PBM. Monitors paid claims for accuracy including for transition supply oversight. Ensures timely communication to members on coverage determination and prescriptions with timeframe restrictions, assesses coverage review accuracy, and triages as needed.
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   Assists in outbound calls to members, providers, and pharmacies to initiate coverage determinations/appeals, prescription refills, and switch members to lower cost therapeutic alternatives based on discussions with providers. Documents all attempts in tracking software.
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   Collaborates with Clinical Intervention Pharmacists on Medicare Stars and other quality initiatives, with a strong focus on member experience. Conducts outreach to Pharmacy Benefit Manager (PBM) for refills, claim reprocessing and to members to provide status of intervention.
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   Tracks and coordinates daily issue/response files with PBM for claim resolution. Outreaches to pharmacy/prescriber as needed.
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   Generates reports from pharmacy system and reviews production metrics. .
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   Supports operational oversight overflow and any additional requests. Responds to Part D and Part B benefit questions, updates tracking documents, and ensures effectuation of claims.
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   Builds and maintains knowledge of new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals, Grievances, and Medicare marketing material requirements.
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   Assists in internal and external audits and projects of the Medicare Part D (pharmacy) and Part C (medical drug) programs as needed.
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   Performs other duties as assigned.
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   Qualifications:
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  Education and Experience:
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   Associate Degree in Business Administration, Healthcare, or related field or equivalent combination of experience, training, and education.
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   4 &ndash; 5 years of experience in a health plan, pharmacy, or PBM operations, which includes exposure to Centers for Medicare &amp; Medicaid Services (CMS) guidelines, preferably Part D.
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   Professional Certification(s):
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   Certified Pharmacy Technician (CPhT) preferred.
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   Technical Skills And Knowledge:
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   Knowledge of CMS guidelines and Medicare Part D (pharmacy).
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   Knowledge of pharmacy claims processing through retail or mail pharmacy.
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   Intermediate Microsoft Office skills (Excel, Word, Power Point).
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  Medicare Pharmacy Coordinator II
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 <strong>
  <strong>
   Job Summary:
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 </strong>
 Working under general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part C (medical drug) benefit programs. Configures, implements, maintains, and services Medicare and Individual pharmacy benefits, with a strong focus on member experience.
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  <strong>
   Responsibilities:
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   <br/>
  </strong>
 </strong>
 <ul>
  <li>
   Coordinates pharmacy reject review and resolution either directly or forwards/escalates to other departments or PBM. Monitors paid claims for accuracy including for transition supply oversight. Ensures timely communication to members on Part D coverage determination, all levels of appeal, re-openings (case re-decision) and Part C organization determination, and prescriptions with timeframe restrictions, assesses coverage review accuracy, and triages as needed.
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   Coordinates remediation efforts for Hospice and End Stage Renal Disease (ESRD) processes.
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   Supports Medicare Pharmacy Specialists in the research and review of Part D and Part B inquiries, grievances, and CTMs, updating tracking documents, audit research items, and marketing material reviews.
  </li>
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   Assists in outbound calls to members, providers, and pharmacies to initiate coverage determinations/appeals, prescription refills, and switch members to lower cost therapeutic alternatives based on discussions with providers. Documents all attempts in tracking software.
  </li>
  <li>
   Collaborates with Clinical Intervention Pharmacists on Medicare Stars and other quality initiatives, with a strong focus on member experience. Conducts outreach to Pharmacy Benefit Manager (PBM) for refills, claim reprocessing and to members to provide status of intervention.
  </li>
  <li>
   Generates reports from pharmacy system and reviews production metrics. Conducts Part D Explanation of Benefits (EOB) audit.
  </li>
  <li>
   Tracks and coordinates daily issue/response files with PBM for claim resolution. Outreaches to pharmacy/prescriber as needed. Supports operational oversight overflow and any additional requests. Responds to Part D and Part B benefit questions, updates tracking documents, and ensures effectuation of claims.
  </li>
  <li>
   Maintains knowledge of new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals, Grievances, and Medicare marketing material requirements. Assists in internal and external audits and projects of the Medicare Part D (pharmacy) and Part C (medical drug) programs as needed.
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   Assists more junior level with any oversight process questions.
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   Performs other duties as assigned.
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   Education And Experience:
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   Associate Degree in Business Administration, Healthcare, or related field or equivalent combination of experience, training, and education.
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   1-2 years of experience as a Medicare Pharmacy Coordinator or equivalent 5-6 years of experience in a health plan, pharmacy, or PBM operations, which includes exposure to Centers for Medicare &amp; Medicaid Services (CMS) guidelines, specifically Part D.
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   Technical Skills And Knowledge:
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 <ul>
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   Strong knowledge of CMS guidelines and Medicare Part D (pharmacy).
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   Strong knowledge of pharmacy claims processing through retail or mail pharmacy.
  </li>
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   Intermediate Microsoft Office skills (Excel, Word, Power Point).
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  </li>
 </ul>
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  A Great Place To Work:
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 Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
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   We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
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   Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
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   On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
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   Discounts at many places in and around town, just for being a Medical Mutual team member.
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   The opportunity to earn cash rewards for shopping with our customers.
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   Business casual attire, including jeans.
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  Excellent Benefits And Compensation:
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   Employee bonus program.
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   401(k) with company match up to 4% and an additional company contribution.
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   Health Savings Account with a company matching contribution.
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   Excellent medical, dental, vision, life and disability insurance &mdash; insurance is what we do best, and we make affordable coverage for our team a priority.
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   Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
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   Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
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   After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
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  An Investment In You:
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   Career development programs and classes.
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   Mentoring and coaching to help you advance in your career.
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   Tuition reimbursement up to $5,250 per year, the IRS maximum.
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   Diverse, inclusive and welcoming culture with Business Resource Groups.
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  About Medical Mutual:
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 Medical Mutual&rsquo;s status as a mutual company means we are owned by our policyholders, not stockholders, so we don&rsquo;t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
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 There&rsquo;s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
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 We&rsquo;re not just one of the largest health insurance companies based in Ohio, we&rsquo;re also the longest running. Founded in 1934, we&rsquo;re proud of our rich history with the communities where we live and work.
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  We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
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Medicare Pharmacy Coordinator

MedOne Benefit Solutions

<div><p><b>Overview: </b>MedOne is seeking a Certified Pharmacy Technician to deliver concierge-level support that helps members access specialty medications, including those sourced internationally. In this dynamic role, you'll guide patients through enrollment, financial assistance, and medication coordination while serving as a trusted liaison between providers, pharmacies, and care teams.</p><p><b>
About MedOne: </b>MedOne is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully</p><p>
transparent, pass-through model, MedOne helps people conveniently access the most appropriate prescriptions at the most affordable price.</p><p><b><br>
What You'll Do:</b></p><ul><li>
Support members in accessing resources and the appropriate site(s) of care, with specialty pharmacies, including internationally sourced partners</li><li>
Provide program and product specific financial knowledge</li><li>
Direct and support members with completion of enrollment requirements</li><li>
Convey pharmacy and claim details in easy-to-understand terms to callers</li><li>
Provide excelled member relations and concierge level style of services</li><li>
Comprehend and explain step therapy and copay requirements</li><li>
Act as a liaison between members, providers, pharmacies, and care facilities</li><li>
Coordinator scheduling of specialty medication delivery</li><li>
Utilize basic de-escalation techniques</li><li>
Maintain and be proactive with assigned case load and timely updates</li><li>
Prepare and provide clear communications verbally and in written formats</li><li>
Support operations of MedOne Member, Clinical, and Pharmacy services</li><li>
Align with, and support MedOne&rsquo;s Core Values</li></ul><p><b>
What You Will Bring to MedOne:</b></p><ul><li>
1 year minimum of customer service experience</li><li>
Pharmacy Technician Certification is highly encouraged. If you don't have it, you will be required to obtain it within one year of employment.</li><li>
Must obtain certification as a pharmacy technician within one year of hire date</li><li>
Strong knowledge of Microsoft Office products including Word, Excel, and Teams</li><li>
Customer empathy skills and proficiency in de-escalating challenging situations</li><li>
Excellent interpersonal, written, and verbal skills</li><li>
Detail orientated, able to work independently, meet deadlines, establish priorities, and be flexible</li><li>
Demonstrated ability to work effectively in a call center or office environment</li><li>
Must be able to stand/sit for long periods of time within limited space</li><li>
Must be able to life up 25 pounds</li></ul><p><b>
Why MedOne?</b></p><p>
At MedOne, we believe that a healthy team is a happy team. We offer a collaborative work environment, competitive benefits, and opportunities for growth&mdash;all while helping to make a difference in people&rsquo;s lives. Our top core value is to<b><i> prioritize your well-being</i></b><i>.</i></p><p>
To support you in living this value, we offer:</p><ul><li>
Competitive salary and bonuses that reward your performance.</li><li>
Comprehensive health, dental, and vision insurance + additional benefits</li><li>
401(k) with company match to secure your future.</li><li>
Generous paid time off and holidays.</li><li>
Opportunities for professional growth and development.</li><li>
A vibrant and collaborative work culture.</li></ul><p><b>
Location: </b>Offices in either Dubuque, IA, or Kansas City, MO, or the position can be remote within the United States.<br>
<b>Employment Type: </b>Full Time, Hourly<br>
<b>Reports to: </b>Patient Care Coordinator Team Lead</p><p><b><br>
How to Apply:</b> If you're enthusiastic about helping others and eager to join a dynamic team, we&rsquo;d love to hear from you. Apply now and take the first step toward a rewarding career at MedOne! You can submit your application through our careers page.<br>
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MedOne is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.<br>
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Job Offers are contingent on passing a background check and drug screen.</p></div>

Specialty Pharmacy Patient Care Coordinator

Elevance Health

<div><p><b>Clinical Support Coordinator - BioPlus Specialty Pharmacy</b></p><p></p><p><b>
Location: </b>LA - Harvey, 2731 Manhattan Blvd or FL &ndash; Lake Mary, 3200 Lake Emma Road</p><p><b>
Schedule: </b>M-F; 830am &ndash; 5pm central time</p><p><b>
Hybrid: </b>This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.</p><p></p><p>
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.</p><p></p><p>
BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies<b>. </b>BioPlus offer consumers and providers an unparalleled level of service that&rsquo;s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer&rsquo;s treatment journey.</p><p></p><p>
The Clinical Support Coordinator - BioPlus Specialty Pharmacy is responsible for participating in program management activities, supporting and facilitating the distribution of reports and communication documents, and assisting with process improvement initiatives designed to improve customer service.</p><p></p><p><b>
Primary duties may include, but are not limited to:</b></p><ul><li><p>
Ensures timely, compliant, and accurate completion of program deliverables.</p></li><li><p>
Prepares and maintains reports for review by departmental management related to assigned program activities.</p></li><li><p>
Collaborates with departments and completes day-to-day activities related to program assignment.</p></li><li><p>
Completes the coordination, authorization, fulfillment, monitoring, and tracking of health care services.</p></li><li><p>
Partners with functional area experts and/or program managers to develop concise, complete, accurate, and clear specifications of program deliverables.</p></li></ul><p></p><p><b>
Minimum Requirements:</b></p><ul><li><p>
Requires a HS diploma or equivalent and minimum of 3 years of experience in a general office/administrative environment; or any combination of education and experience, which would provide an equivalent background.</p></li></ul><p></p><p><b>
Preferred Skills, Capabilities and Experiences:</b></p><ul><li><p>
Managed healthcare experience preferred.</p></li></ul><br>
<p></p>
<p>Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.</p>
<p>Who We Are</p>
<p>Elevance Health is a health company dedicated to improving lives and communities &ndash; and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.</p>
<p>How We Work</p>
<p>At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.</p>
<p>We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.</p>
<p>Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.</p>
<p>The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.</p>
<p>Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.</p>
<p>Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.</p><p>
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.</p></div>

Clinical Support Coordinator - BioPlus Specialty Pharmacy

Onco360

<div><div><b>Are you someone looking for professional career growth? </b>Onco360 Pharmacy is looking for <b>Pharmacy Benefit Verification Specialists</b> for our Pharmacy located in <b>Houston, TX.</b></div>
<div></div><div><div><b>Work Hours: Monday-Friday shifts available; </b><b>some weekends as needed.</b></div><br>
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</div><div></div><div><b>**Starting salary at $24.00/hr and up** </b>We also offer quarterly incentive bonuses.</div><br>
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<div></div><div><div>We offer a variety of benefits including:</div>
<div></div><ul><li>Medical, Dental &amp; Vision insurance</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Paid Volunteer Day</li>
<li>Floating Holiday</li>
<li>Referral Incentive</li>
<li>Paid Life, and short &amp; long-term disability insurance</li>
</ul>
</div><div></div><div><div><b>Pharmacy </b><b>Benefit Verification</b><b> Summary</b></div>
<div>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.</div>
<div></div><div><b>Pharmacy </b><b>Benefit Verification</b><b> Specialist Major Responsibilities:</b></div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information.</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>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.</li>
<li>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.</li>
<li>Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul><div><b>Pharmacy </b><b>Benefit Verification</b><b> Specialist Qualifications:</b></div>
</div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience</li>
</ul></li><li>Work Experience
<ul><li>Required: 1+ years pharmacy or benefit verification experience</li>
<li>Desired: 3+ years pharmacy or benefit verification experience</li>
</ul></li><li>Skills/Knowledge:
<ul><li>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, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.</li>
</ul></li><li>Behavior Competencies
<ul><li>Required: 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 skill</li>
</ul></li></ul><div>Onco360 is a Closed door specialty pharmacy that focuses on patients who are currently undergoing cancer treatment. Our patients are important to us, so we always strive to meet and exceed their needs. We are seeking <b>Pharmacy Benefit Verification Specialists</b> who go above and beyond for our patients, and also passionate about helping others.</div></div><div></div>

Pharmacy Benefits Verification Specialist

<div><div><b>Are you someone looking for professional career growth? </b>Onco360 Pharmacy is looking for <b>Pharmacy Benefit Verification Specialists</b> for our Pharmacy located in <b>New Hyde Park, NY</b><b>.</b></div>
<div></div><div><div><b>Work Hours: Monday-Friday shifts available; </b><b>some weekends as needed.</b></div><br>
<div></div>
</div><div></div><div><div><b>**Starting salary at $25.00/hr and up** </b>We also offer quarterly incentive bonuses.</div><br>
<div></div>
<div></div><div><div>We offer a variety of benefits including:</div>
<div></div><ul><li>Medical, Dental &amp; Vision insurance</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Paid Volunteer Day</li>
<li>Floating Holiday</li>
<li>Referral Incentive</li>
<li>Paid Life, and short &amp; long-term disability insurance</li>
</ul>
</div><div></div><div><div><b>Pharmacy </b><b>Benefit Verification</b><b> Specialist Major Responsibilities:</b></div>
<div>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.</div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information.</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>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.</li>
<li>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.</li>
<li>Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul><div><b>Pharmacy </b><b>Benefit Verification</b><b> Specialist Qualifications:</b></div>
</div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience</li>
</ul></li><li>Work Experience
<ul><li>Required: 1+ years pharmacy or benefit verification experience</li>
<li>Desired: 3+ years pharmacy or benefit verification experience</li>
</ul></li><li>Skills/Knowledge:
<ul><li>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, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.</li>
</ul></li><li>Behavior Competencies
<ul><li>Required: 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 skill</li>
</ul></li></ul><div>Onco360 is a Closed door specialty pharmacy that focuses on patients who are currently undergoing cancer treatment. Our patients are important to us, so we always strive to meet and exceed their needs. We are seeking <b>Pharmacy Benefit Verification Specialist</b>s who go above and beyond for our patients, and also passionate about helping others.</div>
<div></div><div><b>#Company Values: Teamwork, Respect, Integrity, Passion</b></div></div></div><div></div>

<div><div><b>Are you someone looking for professional career growth? </b>Onco360 Pharmacy is looking for <b>Pharmacy Benefit Verification Specialists</b> for our Pharmacy located in <b>Louisville, KY</b><b>.
</b></div>
<div></div><div><div><b>Work Hours: Monday-Friday shifts available; </b><b>some weekends as needed.</b></div><br>
<div></div>
</div><div></div><div><div><b>**Starting salary at $22/hr and up** </b>We also offer quarterly incentive bonuses.</div><br>
<div></div>
<div></div><div>Onco360 is a Closed door specialty pharmacy that focuses on patients who are currently undergoing cancer treatment. Our patients are important to us, so we always strive to meet and exceed their needs. We are seeking <b>Pharmacy Benefit Verification Specialist</b>s who go above and beyond for our patients, and also passionate about helping others.</div>
<div></div><div><div>We offer a variety of benefits including:</div>
<ul><li>Medical, Dental &amp; Vision insurance</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Paid Volunteer Day</li>
<li>Floating Holiday</li>
<li>Referral Incentive</li>
<li>Paid Life, and short &amp; long-term disability insurance</li>
</ul>
</div><div></div><div><div><div><b>Pharmacy </b><b>Benefit Verification </b><b>Specialist Summary:</b></div>
<div>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.</div>
<div></div><div><b>Pharmacy </b><b>Benefit Verification</b><b> Specialist Major Responsibilities:</b></div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information.</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>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.</li>
<li>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.</li>
<li>Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul></div><div><b>Pharmacy </b><b>Benefit Verification</b><b> Specialist Qualifications:</b></div>
</div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience</li>
</ul></li><li>Work Experience
<ul><li>Required: 1+ years pharmacy or benefit verification experience</li>
<li>Desired: 3+ years pharmacy or benefit verification experience</li>
</ul></li><li>Skills/Knowledge:
<ul><li>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, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.</li>
</ul></li><li>Behavior Competencies
<ul><li>Required: 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</li>
</ul></li></ul><div><b>#Company Values: Teamwork, Respect, Integrity, Passion</b></div></div></div>

<div><div><b>Are you someone looking for professional career growth? </b>Onco360 Pharmacy is looking for <b>Pharmacy Benefit Verification Specialists</b> for our Pharmacy located in <b>Buffalo, NY</b><b>.</b></div>
<div></div><div><div><b>Work Hours: Monday-Friday shifts available; </b><b>some weekends as needed.</b></div><br>
<div></div>
</div><div></div><div><div><b>**Starting salary at $22/HR and up** </b>We also offer quarterly incentive bonuses.</div>
<div></div><div><div>We offer a variety of benefits including:</div>
<ul><li>Medical, Dental &amp; Vision insurance</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Paid Volunteer Day</li>
<li>Floating Holiday</li>
<li>Referral Incentive</li>
<li>Paid Life, and short &amp; long-term disability insurance</li>
</ul>
</div><div></div><div><div><div><b>Pharmacy </b><b>Benefit Verification</b><b> Summary</b></div>
<div>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.</div>
<div></div><div><b>Pharmacy </b><b>Benefit Verification</b><b> Specialist Major Responsibilities:</b></div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information.</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>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.</li>
<li>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.</li>
<li>Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul></div><div><b>Pharmacy </b><b>Benefit Verification</b><b> Specialist Qualifications:</b></div>
</div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience</li>
</ul></li><li>Work Experience
<ul><li>Required: 1+ years pharmacy or benefit verification experience</li>
<li>Desired: 3+ years pharmacy or benefit verification experience</li>
</ul></li><li>Skills/Knowledge:
<ul><li>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, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.</li>
</ul></li><li>Behavior Competencies
<ul><li>Required: 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 skill</li>
</ul></li></ul><div>Onco360 is a Closed door specialty pharmacy that focuses on patients who are currently undergoing cancer treatment. Our patients are important to us, so we always strive to meet and exceed their needs. We are seeking <b>Pharmacy Benefit Verification Specialist</b>s who go above and beyond for our patients, and also passionate about helping others.</div></div></div>

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