Senior Pharmacy Benefit Verification Specialist

Location: Louisville, KYJob Id:5132of Openings:1Are you someone looking for professional career growth?Onco360 Pharmacy is looking for SeniorPharmacy Benefit Verification Specialistfor our Pharmacy located in Louisville, KYOnco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.Starting salary at $26/HR and upWe offer a great benefits including:401k with a matchPaid Time Off and Paid HolidaysTuition ReimbursementCompany paid benefits – life; and short and long-term disabilityThe Senior Benefit Verification Specialist will work closely with the Senior Manager, Patient Benefits to ensure completion of challenging cases and escalations in their designated vertical. Senior Benefits Verification Specialists 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. They may also assist with training employees, and other duties as assigned.Works and resolve difficult or escalated cases to assist in processing prescription ordersParticipates in the orientation and training of benefit verification specialists within workflow verticalEscalates workflow/process improvement ideas to leadershipPractices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requestsProvides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit informationEnsures complete and accurate patient setup in CPR+ system including patient demographic and insurance informationPerforms 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 profileRun 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 pharmacyFacilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claimsMaintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality lawsContributes to team effort by accomplishing related tasks as needed and other duties as assignedConducts 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.Education/Learning ExperienceRequired: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits VerificationDesired: Associates or Bachelor's Degree, Certified Pharmacy Technician (PTCB), Specialty pharmacy experienceWork ExperienceRequired: 2+ years pharmacy or benefit verification experienceDesired:3+ years pharmacy or benefit verification experienceSkills/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, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.Desired: Specialty pharmacy experience, leadership skillsLicenses/CertificationsRequired:Registration with Board of Pharmacy as required by state lawDesired: Certified Pharmacy Technician (PTCB)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 skillsJ-18808-Ljbffr