Onco360 Oncology Pharmacy Verified
Pharmaceuticals, Healthcare, Pharmacy
Pharmacy Claims Adjudication Specialist
RemoteRemoteFull Time$25–$25 /hrPosted 1 month ago
Required skills
- Pharmacy Claims Adjudication
- Coordination of Benefits
- Pharmacy/NDC medication billing
- Pharmacy claims resolution
- PBM and Medical contracts
- Medicare
- Medicaid
- Commercial insurance
- NCPDP claim rejection resolution
- CPR+
Nice to have
- Specialty pharmacy experience
- Foundation Funding
Role summary
Onco360 Pharmacy is seeking a full-time Pharmacy Adjudication Specialist for its Specialty Oncology pharmacy. This role involves adjudicating pharmacy claims, resolving rejections, and ensuring accurate patient setup in the CPR+ system. The specialist will handle primary, secondary, and tertiary pharmacy plans, coordinate benefits, and manage funding-related adjudications. Key responsibilities include patient outreach for claim issues, communicating copay discrepancies, and processing patient refunds. The position requires a High School Diploma or GED, 2+ years of experience in a pharmacy/healthcare setting or pharmacy claims, and an active Indiana Pharmacy Technician credential. Desired qualifications include an Associate's degree, Certified Pharmacy Technician status, and specialty pharmacy experience. The role offers remote work flexibility with a starting salary of $25.00/hour and a $5,000 sign-on bonus.
We are seeking a Pharmacy Adjudication Specialist for our Specialty Oncology pharmacy. As our company continues to grow, we strive to hire new team members with a passion for making a difference in our patient's lives. Full-Time position may work remotely but MUST HAVE ACTIVE INDIANA PHARMACY TECHNICIAN credentials from the State Board of Pharmacy. Shift times between 8am and 8pm. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $25.00 an hour and up Sign-On Bonus: $5,000 for employees starting before October 31st, 2026. We offer a variety of benefits including:
- Medical; Dental; Vision
- 401k with a match
- Paid Time Off and Paid Holidays
- Tuition Reimbursement
- Company paid benefits – life; and short and long-term disability
- 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 active claims information..
- Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
- Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
- Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
- Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
- Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
- Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
- Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
- Documents and submit requests for Patient Refunds when appropriate.
- Maintain 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, Pharmacy Claims Adjudication
- Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
- Work Experience
- Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
- Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
- Skills/Knowledge
- Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, 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
- Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
- Licenses/Certifications
- Required: Pharmacy Technician License/Registration with Board of Pharmacy as required by state law
- Behavior Competencies
- 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 skills
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