Pharmacy Benefits Verification Specialist

Job Description

Location: Louisville, KY (On-site)

We are seeking a Pharmacy Benefits Verification Specialist to support a shared services center by verifying pharmacy benefits and coordinating specialty drug access. This position is a full-time, direct hire opportunity based on-site in Louisville, KY.

This role is an excellent entry point into the pharmacy reimbursement and managed care industry for candidates who work independently in a structured, high-volume call-center environment and take pride in getting the details right. It is ideally suited for candidates with a background in pharmacy technician work, insurance customer service, medical billing, or prior authorization, and who are ready to deepen their expertise in specialty drug access, hub operations, and the full reimbursement lifecycle. The position offers an on-site schedule, exposure to a wide cross-section of commercial and government payers, and a clear pathway into senior verification, reimbursement coordination, or prior authorization roles.

Responsibilities:

• Conduct outbound calls to Medicare, Medicaid, commercial plans, and PBMs for specialty medication benefits verification.
• Verify pharmacy and medical benefit eligibility, dates, IDs, plan types, and secondary payer coordination.
• Determine cost-sharing including deductibles, accumulators, copays, coinsurance, and specialty tier placement.
• Identify medication coverage, confirm billing pathway (specialty pharmacy or buy-and-bill), and document payer requirements.
• Identify prior authorization requirements and initiate PA requests with clinical documentation for prescribers.
• Track authorization timelines, follow up on pending PA cases, and escalate urgent issues.
• Document benefits investigation findings in patient management systems for audit-ready care team access.
• Communicate benefit findings to patients, explaining costs and available assistance programs.
• Enroll eligible patients in manufacturer assistance programs by completing forms and verifying documentation.

Qualifications:

• Require a high school diploma or GED; an Associate or Bachelor’s degree in health sciences preferred.
• Bring a minimum of 1 year of pharmacy benefits verification, eligibility, authorization, or specialty pharmacy hub experience.
• Understand PBM terminology, benefit structures, and government payer rules for Medicare and Medicaid.
• Demonstrate proficiency with payer portals like Availity and NaviNet and with patient management systems.
• Conduct professional, empathetic calls; manage volume while de-escalating sensitive financial conversations with patients.
• Document case details accurately and quickly across multiple systems using Microsoft Office.

Schedule:

On-site in Louisville, KY. Standard business hours, Monday through Friday.

Salary Range: The salary range for this position is approximately $38,000 – $52,000 annually ($18.27 – $25.00 per hour), based on experience and qualifications.

Interview Process:

• Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.