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Benefits Verification Operations Excellence Manager - Remote

Remote:

Full Remote

Contract:

Full time

Experience:

Mid-level (2-5 years)

Work from:

California (USA), Illinois (USA), United States

Offer summary

Qualifications:

Bachelor's degree in Business or Healthcare Administration, Previous experience in benefit verification or pharmacy billing, Strong knowledge of insurance plans and reimbursement processes, Excellent analytical and problem-solving skills, Proficient in pharmacy management systems and Microsoft Office Suite.

Key responsabilities:

Provide guidance, training and feedback to ensure quality work output
Develop SOPs for benefit verification processes and ensure adherence to guidelines
Review insurance eligibility, verify coverage, stay updated on policies
Implement quality control measures, monitor accuracy and efficiency
Collaborate with IT vendors for process automation and improvements

Orsini Specialty Pharmacy Pharmaceuticals SME https://www.orsinispecialtypharmacy.com/

See more Orsini Specialty Pharmacy offers

Job description

Description

About Orsini Specialty Pharmacy

Providing patients with comprehensive and compassionate care since 1987, Orsini Specialty Pharmacy is a leader in rare diseases and gene therapies. Orsini partners with biopharma innovators, healthcare providers, and payors to support patients and their families in accessing revolutionary treatments for rare diseases. Through integrated pharmacy distribution, patient services, clinical management and convenient home infusion services, Orsini delivers customized solutions that simplify how patients connect to advanced therapies. Orsini’s high-touch care model centers on experienced and trained therapy care teams that provide personalized patient care to ensure that No Patient is Left Behind™. Orsini Specialty Pharmacy holds accreditations with the Accreditation Commission for Health Care (ACHC), The Joint Commission, URAC and NABP. Orsini has earned URAC’s Rare Disease Pharmacy Center of Excellence Designation and ACHC's Distinction in Rare Diseases and Orphan Drugs.

Our Mission

Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.

LIVE IT Values

At the heart of our company culture, the Orsini LIVE IT core values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.

Leading Quality, Integrity, Valued Partner, Empathy, Innovation, Team-First

Position Summary
The Benefit Verification Process Improvement Manager is responsible for overseeing the benefit verification process within a specialty and home infusion pharmacy. This position requires strong attention to detail, excellent analytical skills, a thorough understanding of insurance and reimbursement processes and the ability to influence others without authority. The successful candidate will work directly with the benefits verification team to ensure accurate and timely verification of insurance benefits, implement quality control measures and optimize efficiency and compliance.

Required Knowledge, Skills & Training

Bachelor's degree in Business, Healthcare Administration, or a related field (or equivalent work experience)
Previous experience in benefit verification, insurance eligibility, or pharmacy billing, preferably in a specialty and home infusion pharmacy setting
Strong knowledge of insurance plans, coverage criteria, and reimbursement processes, including Medicare, Medicaid, and commercial payers
Familiarity with pharmacy operations, including medication types, dosage forms, and specialty therapies
Excellent analytical and problem-solving skills, with the ability to interpret complex insurance and reimbursement information
Ability to influence without authority
Strong attention to detail and ability to maintain accuracy while working in a fast-paced environment
Proficient in using pharmacy management systems, billing software, and Microsoft Office Suite
Excellent verbal and written communication skills, with the ability to effectively interact with internal and external stakeholders
Knowledge of HIPAA regulations and commitment to maintain patient privacy and data security

Essential Job Duties

Providing guidance, oversight, training, and performance feedback to ensure high-quality work output
Develop and maintain standard operating procedures (SOPs) for benefit verification processes and ensure adherence to established guidelines
Review and analyze insurance eligibility and benefits information to verify coverage for specialty and home infusion pharmacy services
Stay up to date with insurance policies, coverage criteria, and reimbursement guidelines to ensure accurate benefit verification and claims processing
Implement quality control measures, including regular audits and performance metrics, to monitor the accuracy and efficiency of benefit verification processes. Maintain accurate and organized records of benefit verification activities, ensuring compliance with privacy and data protection regulations
Responsible for helping to develop policies and procedures and process improvement strategies within the department. Communicates procedure changes to departments affected by that change
Collaborate with IT or software vendors to optimize benefit verification systems and tools, identifying opportunities for automation and process improvements
Participate in cross-functional meetings and projects to contribute to the overall operational efficiency and effectiveness of the pharmacy

Employee Benefits