Medical benefits verification supervisor

Are you someone looking for professional career growth? Onco360 Pharmacy is looking for a Medical Benefits Verification Supervisor for our Pharmacy located in Louisville, KY.

Work Hours: Monday-Friday 8:30-5 EST.

Starting salary is $61,000/annually. We 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 Benefits Verification Supervisor is responsible to support the Medical Benefits Verification Specialist roles while performing insurance authorization and verification for all patients scheduled for services. The Supervisor 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.

Medical Benefits Verification Specialist Major Responsibilities:

• Support staff in verifying Commercial and Government payer 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.
• Facilitate process for requesting medical authorizations, Single Case Agreements, Letter of Agreements, and Terms of Agreement for applicable commercial, Medicaid, and Medicare, or facility medication claims.
• Investigate payer plans: Research and document benefit plan specifics for various payer plans, including cost-share responsibilities and restrictions.
• Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.
• Develop expertise: Maintain in-depth knowledge of insurance policies, coverage terms, and complex billing practices.
• Identify the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements for approval.
• Handle complex cases: Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.
• Collaborate across departments: Work closely with clinical staff, billing and coding teams, and administrative teams to resolve insurance issues and ensure seamless patient care.
• Will be the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated.

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:

3+ years’ Medicare and Medical benefit verification experience, previous leadership experience.

Desired:

5+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience, 1+ years supervisor 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.