Pharmacy Verification Specialist

“Choose a job you love and you will never have to work a day in your life.” ~ Confucius

Location: Waltham, MA

Job :668

# of Openings:1

Care Med Pharmacy is looking for Pharmacy Benefit Verification Specialists for our growing Pharmacy!

Work Hours: Monday-Friday shifts available; some weekends as needed. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.

Starting salary: $24.00/hr and up. We also offer quarterly incentive bonuses.

Sign-On Bonus: $5,000 for employees starting before July 31, 2026.

We offer a variety of benefits including:

• 401k with a match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Floating Holiday
• Referral Incentive
• Paid Life, and short & long-term disability insurance

• Investigates, reviews, and loads accurate patient insurances, including medical and pharmacy coverage, assigns coordination of benefits, runs test claims to obtain a valid insurance response on patient medications, investigates/identifies authorization requirements needed to obtain medication coverage, and enrolls eligible patients in copay card assistance programs. Ensures accurate benefit documentation is made for all prescription orders.
• Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
• Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information.
• Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
• Performs full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profile.
• Runs test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement, then documents outcome of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy.
• Facilitates process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.
• Maintains a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
• Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• 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:
    
    1+ years pharmacy or benefit verification experience
  • Desired: 3+ years pharmacy or benefit verification experience
• Skills/Knowledge
  • Required:
    
    Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
• 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 skill