Pharmacy Benefit Verification Specialist
Onco360 - Louisville, KY
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Our Onco360 Corporate Office in Louisville, Kentucky has an immediate need for a Pharmacy Billing Specialist
We offer a great benefits including:
- Medical; Dental; Vision
- 401k with a match
- Paid Time Off and Paid Holidays
- Tuition Reimbursement
- Company paid benefits – life; and short and long-term disability
Pharmacy Benefit Verification Specialist Major Responsibilities:
- Ensure complete and accurate patient setup in CPR+ system.
- Perform Insurance eligibility for patients as requested by Operations. Provide thorough, accurate and timely responses to request.
- Facilitate process for requesting Prior Authorizations for Commercial and Medicare D medication claims.
- Assist operations with all Electronically adjudicated claims to ensure all Rx reconciled and paid for prior to delivery.
- Follow up on all unpaid claims and aging A/R items.
- Participate in Third Party and/or Medicare claim audits in order to minimize financial exposure.
Pharmacy Benefit Verification Specialist Qualifications:
- Education/Learning Experience
- Required: High School Diploma or equivalent.
- Desired: Associates degree or higher
- Work Experience
- Required: 2-3 years experience as a Billing Specialist
- Desired: 4+ years experience as a Billing Specialist; pharmacy technician with adjudication experience; CPR+, QS1, Frameworks
- Required: NDC Medication Billing, Understanding of Medicare programs and components
- PBM and Secondary claims
- Medicare Part D and Medicaid
- Long Term and Retail Pharmacy Billing
- NCPDP rejections
- DUR rejections
- Desired: National of State Pharmacy Tech Certification
- Behavior Competencies
- Required: Deadline Oriented, Time Management, Prioritization Skills