Benefits Verification Operations Excellence Manager - Remote
Description
About Orsini Specialty Pharmacy
"Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™."
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.
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
- BCBSL Medical
- Delta Dental
- EyeMed Vision
- 401k
- Accident & Critical Illness
- Life Insurance
- PTO, Holiday Pay, and Floating Holidays
- Tuition Reimbursement