Hybrid Pharmacy Claims Adjudication Specialist

Onco360 Oncology Pharmacy; Buffalo (NY); Hybrid; USD 48,000 - 60,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401k with match

PTO & Holidays

Tuition Reimbursement

Life & Disability Insurance

Job summary

Onco360 Pharmacy in Buffalo, NY is hiring a Pharmacy Adjudication Specialist for a full-time, hybrid role. The position involves adjudicating claims, resolving third-party rejections, and communicating with payers and patients to ensure timely delivery of medications.

Starting hourly wage is $23 with a $5,000 sign-on bonus for hires before 12/31/2026. Benefits include medical, dental, vision, 401k match, PTO, tuition reimbursement and life/disability coverage.

Qualifications

• Must have pharmacy/healthcare claims adjudication experience.
• Knowledge of Medicare/Medicaid and commercial insurance.
• Experience with pharmacy billing and NCPDP processes.
• Registration with state Board of Pharmacy as required

Responsibilities

• Adjudicate pharmacy claims for prescriptions in active workflow.
• Resolve third-party claim rejections and obtain overrides when appropriate.
• Notify patients about delays due to insurance issues and reschedule as needed.
• Ensure accurate patient setup and demographics in CPR+ system.
• Communicate with providers and payers to expedite claim resolution.

Skills

Pharmacy billing/NDC

Pharmacy claims resolution

PBM & contracts

Medicare/Medicaid knowledge

NCPDP rejection resolution

Coordination of benefits

Pharmacy terminology & sig codes

Brand/generic names

Basic math & analytical skills

Typing speed

Education

High School Diploma or GED

Associate degree or 2-year program

Certified Pharmacy Technician (PTCB)

Tools

CPR+ system

Job description

Onco360 Pharmacy in Buffalo, NY is hiring a Pharmacy Adjudication Specialist for a full-time, hybrid role. The position involves adjudicating claims, resolving third-party rejections, and communicating with payers and patients to ensure timely delivery of medications.

Starting hourly wage is $23 with a $5,000 sign-on bonus for hires before 12/31/2026. Benefits include medical, dental, vision, 401k match, PTO, tuition reimbursement and life/disability coverage.