[Hiring] Benefit Verification Technician @American Oncology Network

Role Description

The role involves various key performance areas focused on insurance verification, specialty pharmacy referrals, claims resolution, communication, and compliance.

• KPA 1 – Insurance Verification
  • Verify Private, Medicaid, and Medicare insurance coverages (include VA, IHS, and other unique programs).
  • Complete patient facility verifications and determine medication coverage.
  • Verify patient eligibility to utilize AON Pharmacy via test claim to their pharmacy insurance.
  • Refer prescriptions to Prior Authorization or Financial Assistance teams based on test claim responses.
  • Offer and enroll patients in manufacturer copay cards for commercial payors to assist in covering patient financial responsibility.
• KPA 2 – Specialty Pharmacy Referrals
  • Determine network coverage for specialty oncology and hematology medications.
  • Determine which pharmacy can dispense on behalf of the patient.
  • Inform patients of prescription referral to outside pharmacies and notify nursing staff to forward prescription.
  • Document prescription referrals in the EMR system to alert physicians and clinic staff of the appropriate dispensing pharmacy.
• KPA 3 – Claims Resolution
  • Obtain Limited Distribution Overrides for AON Pharmacy to fill.
  • Understand claim responses regarding patient plan structure and educate patients regarding financial responsibility.
  • Resolve COB coverage issues with patients and payor to correctly adjudicate claims.
  • Resolve any claim submission issues with outside dispensing pharmacies that are outside the scope of the Intake team.
• KPA 4 – Pharmacy Call Center Communication
  • Ensure effective communication and premier customer service with all internal and external customers.
  • Demonstrate the ability to actively listen and understand patient questions and provide accurate answers and solutions.
  • Act as a liaison between teams to communicate changes and help improve interdepartmental processes to improve patient care.
  • Review incoming team emails to verify they are answered in a timely and professional manner.
• KPA 5 – Compliance
  • Ensure all local, state, and federal guidelines are followed as well as corporate policies, pharmacy Standard Operating Procedures (SOPs) and accreditation bureaus’ standards.
  • Verify all department compliance training is completed by the established deadlines.
  • Maintain continuing education requirements for licensure.
  • Maintain and ensure the confidentiality of all patient and employee information as required by HIPAA regulations.
  • Assist department management in ensuring the storage, collection, and destruction of all Protected Healthcare Information adheres to all federal and state guidelines, in addition to all accreditation standards.
  • Perform other duties and projects as assigned.

Qualifications

• High school education, GED, or equivalent required.
• Active/Unrestrictive Pharmacy Technician permit in the state of residence. Willing to obtain Florida Technician permit (if applicable).
• Two years’ experience in specialty, retail, mail order, or hospital pharmacy as a pharmacy technician is required.

Requirements

• Core Capabilities:
  • Analysis & Critical Thinking: Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills. Must be detail oriented with the ability to exercise independent judgment.
  • Interpersonal Effectiveness: Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness.
  • Communication Skills: Good command of the English language. Second language is an asset but not required. Effective communication skills (oral, written, presentation), is an active listener, and effectively provides balanced feedback.
  • Customer Service & Organizational Awareness: Strong customer focus. Ability to build an engaging culture of quality, performance effectiveness and operational excellence.
  • Self-Management: Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with ability to work independently with limited supervision.
  • Computer Skills: Proficiency in MS Office Word, Excel, Power Point, and Outlook required.
• Travel: 0% < 25%
• Standard Core Workdays/Hours: Monday to Friday 8:30 AM – 5:00 PM local residence time. Occasional overtime may be required, and weekend shifts based on location hours and operational needs.