Benefits and Eligibility Verification Coordinator

$41,600 - $45,760/Yr

California Specialty Pharmacy - Whittier, CA

Full-time - Entry Level

Whittier, CA

Chemical Manufacturing

About the position

The Benefits and Eligibility Verification Coordinator at California Specialty Pharmacy is responsible for verifying insurance eligibility and benefits for members, ensuring accurate data entry and communication with health plans. This role requires a strong attention to detail and the ability to navigate multiple information systems while adhering to healthcare regulations.

Responsibilities

• Obtain members medical benefits in detail along with risk, copay and/or co-insurance information.
• Create physician profile in computer systems, demographics.
• Keep current and compliant with statutes, rules and regulations related to pharmacy.
• Participate in continuous improvement and quality assurance programs.
• Input insurance information, pharmacy and medical.
• Resolve aspects of specialty pharmacy and medical including Medicare, Medicaid, PBM, PPO and IPA and communicate with payers and advise patients or physician of results when needed.
• Communicate with various pharmacy departments as needed to coordinate timely prescription adjudication to meet schedules.
• If necessary, contact physician offices.
• Report errors, omissions or incidents to pharmacists.
• Participate in quality program initiatives and improvement activities.
• Comply with all regulatory requirements, including HIPAA/HITECH.
• Other responsibilities as assigned by Management.

Requirements

• High School degree or equivalent G.E.D required.
• Knowledge of Microsoft Word, Excel; ability to work with multiple information systems.
• Knowledge of medical and pharmaceutical terminology (ICD-10, J-codes).
• Pharmacy or medical office experience preferred.
• HMO, PPO, Medicare Insurance knowledge.
• 45 wpm typing speed.

Nice-to-haves

• General knowledge of pharmacy and healthcare laws and regulations.
• Experience in patient-centered care.
• Decision making skills.
• Team working skills.
• Communication skills.
• Strong problem-solving skills.
• Customer service skills.

Benefits

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance