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Full-time
high school, associate degree
Medical insurance, Dental insurance, Vision insurance, 401k with match, Paid time off, Paid holidays
Posted 6d ago
~40 hrs/week
Responsibilities
The specialist will investigate and verify patient insurance coverage, including government and commercial plans, to ensure accurate medication authorization. They are responsible for documenting benefit outcomes in the CPR+ system and communicating effectively with providers, patients, and insurance carriers.
Requirements
Candidates must have a high school diploma or GED and at least one year of experience in Medicare and medical benefit verification. Proficiency in pharmacy or healthcare-related billing and strong analytical skills are required for this role.
Full job description
Are you someone looking for professional career growth? Onco360 Pharmacy is looking for a Medical Benefits Verification Specialist for our Pharmacy located in Woodridge, IL.
Work Hours: Monday-Friday 8:30-5 EST, may adjust according to Time Zone of candidate.
Starting salary at $23/hourWe also offer quarterly incentive bonuses.
We offer a variety of benefits including:
Medical, Dental & Vision insurance
401k 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
Medical Benefits Verification Specialist Summary:
The Medical Benefit Verification Specialist will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and investigate/identify authorization requirements needed to obtain medication coverage. They will ensure accurate insurance benefit documentation is made for specific IV and oral therapy orders.
Medical Benefits Verification Specialist Major Responsibilities:
Verify Government payer (i.e. Medicare and Medicaid) eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contacting Medicare or other relevant government payers to confirm coverage and benefits for specific services.
Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. Confirming patient eligibility and benefits with various commercial insurance carriers (i.e. Aetna, Humana, Anthem, Cigna, etc.).
Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information and patient copays, deductibles and Out-of-Network responsibilities.
Determine optimal reimbursement based on medical plan and dispensing location, 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.
Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information, doctors’ notes, assessments and lab reports.
Communicate succinctly and professionally both verbally and through written correspondence with Physician offices, nurses, insurance companies and patients as needed.
Exhibits a positive, courteous, respectful, and helpful attitude towards patients, team members, payers, and management. Contributes team effort by accomplishing related tasks as needed and other duties as assigned.
Research proper billing policies and procedures for all payer types, ensuring claims are processed correctly against industry and government standards and regulations, adhere to company compliance, integrity, patient privacy, and ethical billing practices.
Conducts 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 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’ Medicare and Medical benefit verification experience
Desired: 3+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience
Skills/Knowledge
Required: Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits, Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, basic math and analytical skills, Intermediate typing/keyboarding skills.
Desired: Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience
Licenses/Certifications
Required: None
Desired: Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB)
Behavior Competencies
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
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.
We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.
Related keywords
Medical Benefits VerificationPharmacyOncologyMedicareMedicaidCommercial InsuranceCPR+ SystemAuthorizationBillingHealthcarePatient ProfileEligibilityInfusionSpecialty PharmacyPTCBCompliance
Onco360 is recognized as one of the nation's leading independent specialty pharmacies dedicated exclusively to oncology and rare disease patients. Through its comprehensive patient support programs, clinical expertise, and commitment to personalized care, we play a critical role in helping patients access, manage, and adhere to complex therapies while navigating the challenges associated with cancer treatment.
We focus on delivering specialized pharmacy services and improving the patient experience positions us at the forefront of healthcare innovation. By collaborating with healthcare providers, pharmaceutical manufacturers, and patient communities, Onco360 is helping bridge the gap between therapeutic innovation and real-world patient outcomes.
In its focus to bring together the stakeholders involved in the cancer treatment process, Onco360 is advancing the continuum of oncology pharmaceutical care through patient advocacy, dispensing excellence, and the clinical experience and expertise that comes from its focus in oncology.
Onco360 is headquartered in Louisville, KY and dispenses nationally through its network URAC, ACHC, NAPB, and JCAHO accredited Oncology Pharmacies.
Offices: 13410 Eastpoint Centre Dr, Louisville, Kentucky 40223, US · 335 Bear Hill Road, Waltham, MA 02451, US · 140 John James Audubon Pkwy, Suite 101, Amherst, New York 14228, US · 1985 Marcus Ave suite 120, New Hyde Park, NY 11021, US · 4700 W Sam Houston Pkwy N, Suite 150, Houston, Texas 77041, US
Oncology PharmacyInsurance and Benefit InvestigationsSpecialty PharmacyOncology-Specific PharmacyIndependent Oncology PharmacyBoard Certified Oncology PharmacistsLimited Distribution MedicationsCancer CareOncology Specialty PharmacyMedication Therapy Management Programs
Onco360 is recognized as one of the nation's leading independent specialty pharmacies dedicated exclusively to oncology and rare disease patients. Through its comprehensive patient support programs, clinical expertise, and commitment to personalized care, we play a critical role in helping patients access, manage, and adhere to complex therapies while navigating the challenges associated with cancer treatment.
We focus on delivering specialized pharmacy services and improving the patient experience positions us at the forefront of healthcare innovation. By collaborating with healthcare providers, pharmaceutical manufacturers, and patient communities, Onco360 is helping bridge the gap between therapeutic innovation and real-world patient outcomes.
In its focus to bring together the stakeholders involved in the cancer treatment process, Onco360 is advancing the continuum of oncology pharmaceutical care through patient advocacy, dispensing excellence, and the clinical experience and expertise that comes from its focus in oncology.
Onco360 is headquartered in Louisville, KY and dispenses nationally through its network URAC, ACHC, NAPB, and JCAHO accredited Oncology Pharmacies.
Offices: 13410 Eastpoint Centre Dr, Louisville, Kentucky 40223, US · 335 Bear Hill Road, Waltham, MA 02451, US · 140 John James Audubon Pkwy, Suite 101, Amherst, New York 14228, US · 1985 Marcus Ave suite 120, New Hyde Park, NY 11021, US · 4700 W Sam Houston Pkwy N, Suite 150, Houston, Texas 77041, US
Oncology PharmacyInsurance and Benefit InvestigationsSpecialty PharmacyOncology-Specific PharmacyIndependent Oncology PharmacyBoard Certified Oncology PharmacistsLimited Distribution MedicationsCancer CareOncology Specialty PharmacyMedication Therapy Management Programs