Insurance Verification Specialist

Location:AON PharmacyPay Range:$25.19 - $44.31Position SummaryThe Benefit Verification Technician Team Lead is responsible for performing all Benefit Verification Technician duties while providing day-to-day leadership, workflow coordination, quality oversight, and training for the Benefit Verification team. The Team Lead serves as the department's subject matter expert, assisting leadership with daily operations, productivity monitoring, process improvements, and ensuring high-quality patient service.Demonstrates advanced knowledge of benefit verification, specialty pharmacy operations, insurance requirements, pharmacy applications, and organizational policies and procedures. Performs all duties in accordance with regulatory requirements and organizational policies while fostering a culture of teamwork, accountability, continuous improvement, and operational excellence.Key Performance AreasKPA 1 – Operational Leadership & Workflow CoordinationCoordinate daily workflow and prioritize team assignments to ensure service level expectations are achieved.Monitor work queues and identify ageing orders requiring immediate attention.Assist the Pharmacy Operations Supervisor with workload balancing and operational planning.Serve as the first point of contact for complex benefit verification questions and escalations.Communicate daily priorities, operational updates, and workflow changes to the team.Identify workflow inefficiencies and recommend process improvements.Lead by example while maintaining individual productivity expectations.Develop and maintain workflow training materials and assist with onboarding, training, and coaching team members to ensure consistency, accuracy, and adherence to departmental processes.KPA 2 – Data Entry, Documentation & NavigationEnsure the accurate and timely documentation of patient information into multiple software systems.Monitor timely creation of orders in ePrescribe and double check patient demographic information has been entered into the pharmacy software system.Demonstrate advanced knowledge of EMRs and pharmacy software applications.Ensure complete and accurate patient setup within pharmacy operating systems.Review documentation for accuracy and completeness while coaching team members on best practicesKPA 3 – Insurance VerificationVerify Private, Medicaid, and Medicare insurance coverages (include VA, IHS, and other unique programs).Complete patient facility (Hospital, Hospice, Rehab, ALF, Skilled Nursing, etc.) verifications and determine medication coverage.Verify patient eligibility to utilize AON Pharmacy services by reviewing pharmacy insurance benefits, network participation, and claim adjudication results.Refers prescriptions to our Prior Authorization or Financial Assistance teams based on claim adjudication results.Identify eligible manufacturer copay assistance opportunities and coordinate referrals to the Patient Assistance Program (PAP) team for enrollment and processing.Provide guidance and support to team members regarding insurance verification responsibilities, and assist the Pharmacy Operations Supervisor with workflow coordination, issue resolution, training, and daily operational oversight as needed.KPA 4 – Specialty Pharmacy ReferralsDetermine specialty pharmacy network participation.Identify the appropriate dispensing pharmacy for specialty medications by determining network participation, limited distribution requirements, and Risk Evaluation and Mitigation Strategy (REMS) program eligibility.Oversee and coordinate referrals to external specialty pharmacies, ensuring timely processing, accurate documentation, and effective communication with patients, providers, and dispensing pharmacies.Ensure timely and effective communication with patients, clinic staff, and nursing teams by utilizing appropriate documentation, EMR workflows, phone, and email communication to facilitate continuity of care and prescription processing.Support the Pharmacy Operations Supervisor by reviewing external specialty pharmacy referral workflows with team members, providing guidance, and reinforcing process expectations.Assist with the resolution of complex referral situations by providing guidance, troubleshooting barriers, and collaborating with internal teams, clinics, and external specialty pharmacies to ensure timely patient access to medication.KPA 5 – Claims ResolutionTroubleshoot and resolve complex claim adjudication issues by interpreting payer responses, addressing coverage barriers, and providing guidance to team members as needed.Obtain Limited Distribution overrides when appropriate and provide guidance to team members regarding the required processes, documentation, and workflow steps to support timely access to specialty medications.Resolve coordination of benefits (COB) issues.Assist team members with complex payer requirements.Partner with all AON team members to resolve patient access barriers, including but not limited to Prior Authorization, Financial Assistance, Dispensing, and Clinical teams inside the pharmacy as well as clinic staff.Evaluate payer-related barriers and escalate unresolved issues to leadership when appropriate, ensuring all necessary information is documented and communicated to support effective resolution.KPA 6 – Team Development & Quality AssurancePromote effective communication and exceptional customer service across all internal and external interactions by modeling professional behavior, supporting team members, and reinforcing patient-centered service expectations.Demonstrate the ability to actively listen and understand patient questions and provide accurate answers and solutions. Will ensure that all phone calls are addressed professionally, courteously and in a timely manner.Monitor team email communications to ensure responses are timely, professional, and aligned with departmental expectations. Work with the Pharmacy Operations Supervisor to provide coaching to team members and intervene as needed to address concerns, clarify workflows, and support effective communication.Assist the Pharmacy Operations Supervisor to promote consistency and operational excellence across the team by supporting standardized workflows, coaching team members on process expectations, and assisting with quality audits and performance reviews as needed.KPA 7 – Pharmacy Call Center CommunicationDemonstrate exceptional customer service to patients, providers, clinics, and internal departments.Serve as a subject matter expert and departmental resource for benefit verification questions, providing guidance and support to team members to promote accuracy, consistency, and timely resolution.Facilitate communication between operational teams.Review incoming department communications to ensure timely responses.Assist leadership in resolving escalated patient or provider concerns.Promote professional and respectful communication across all departments.KPA 8 – ComplianceVerify 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 the HIPAA regulations. Will assist department management in ensuring the storage, collection, and destruction of all Protected Healthcare Information is adherent to all federal and state guidelines, in addition to all accreditation standards.Position QualificationsEducationHigh school diploma, GED, or equivalent required.Minimum Relevant ExperienceMinimum two (2) years of experience as a Pharmacy Technician in a specialty, retail, mail order, or hospital pharmacy.Experience working in a fast-paced, multi-site healthcare environment with competing priorities preferred.Demonstrated ability to work independently with minimal supervision, including remote work when required.Experience supporting operational initiatives, process improvements, and team collaboration preferred.Certifications/LicensesActive, unrestricted Pharmacy Technician permit in the state of residence required.Willingness to obtain a Florida Pharmacy Technician permit, if applicable.SkillsStrong critical thinking, analytical, problem-solving, decision-making, and organizational skills.Excellent time management with strong attention to detail and sound independent judgment.Strong interpersonal, collaboration, conflict resolution, delegation, and relationship-building skills.High level of professionalism, emotional intelligence, diplomacy, discretion, and confidentiality.Effective verbal and written communication skills in English; bilingual skills are a plus.Strong customer service orientation with the ability to build positive relationships with patients, providers, and internal stakeholders.Ability to manage multiple priorities and adapt in a fast-paced environment.Self-motivated with the ability to work independently and as part of a team.Proficient in Microsoft Word, Excel, PowerPoint, and Outlook.Knowledge of ONCO, ORCA, and CPR+ preferred.Demonstrated commitment to teamwork, operational excellence, continuous improvement, and AON's C.A.R.E. Values.Travel: 0-25%Expectations for All EmployeesThis position description reflects the general duties and responsibilities necessary to perform the principal functions of the job, as identified, and shall not be considered an exhaustive list of job responsibilities which may be inherent in the job. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. The responsibilities listed may be subject to change at any time and individuals may be asked to perform duties outside of their regular responsibilities to support the ongoing business operation needs.Americans with Disabilities Act (ADA) ComplianceThe essential functions described herein are intended to define the fundamental duties of the position and serve as the minimum requirements for performance. They do not represent an exhaustive list of all job duties that may be required. AON complies with the Americans with Disabilities Act (ADA) and applicable state and local laws. The Company will engage in an interactive process to evaluate and, where appropriate, provide reasonable accommodations to qualified individuals with disabilities, provided such accommodations do not impose an undue hardship on the business.Physical RequirementsSitting for extended periodsOccasional walking and standingAbility to use computer and phoneCognitive RequirementsInterpersonal communicationData entry accuracyUnderstanding of billing and insurance proceduresEnvironmental RequirementsOffice environment within patient care areasPotential exposure to airborne illnessesAccommodation NotesErgonomic seatingFlexible schedulesAccessible workstationsScreen reader software#LI-ONSITE #J-18808-Ljbffr