Hybrid Pharmacy Claims Adjudication Specialist

Onco360; Houston (TX); Hybrid; USD 29,000 - 33,000; Full time

Benefits offered by this job

401k with match

Paid Time Off and Paid Holidays

Tuition Reimbursement

Life insurance

Disability insurance

Job summary

Onco360 is seeking a Pharmacy Claims Adjudication Specialist in Houston, TX. This full-time role requires adjudicating pharmacy claims, resolving third-party rejections, and communicating with patients regarding insurance issues.

The position offers hybrid work, a starting wage of $21 per hour, and a $5,000 sign-on bonus for hires before year-end 2026. Responsibilities include CNN: handling CPR+ system entries, ensuring accurate patient demographics and coverage, and collaborating with the

Qualifications

• High School Diploma or GED required; pharmacy claims adjudication experience preferred.
• 2+ years experience in Pharmacy/Healthcare or pharmacy claims.
• Registered with Board of Pharmacy as required by state law.
• Certified Pharmacy Technician (PTCB) desired.
• Strong communication and ability to work independently.

Responsibilities

• Adjudicates pharmacy claims and reviews responses for accuracy.
• Resolves third-party rejections and obtains overrides when appropriate.
• Performs patient outreach regarding delays due to insurance.
• Ensures patient setup in CPR+ with accurate demographics and insurance.
• Contacts insurers to resolve rejections and reschedule shipments.
• Handles copay cards eligibility and collects payments if needed.
• Maintains confidentiality and compliance with laws.

Skills

Pharmacy billing

Claims resolution

Coordination of benefits

Medicare/Medicaid knowledge

NCPDP rejection handling

Pharmacy terminology

Basic math & analytical skills

Typing / keyboarding

Education

High School Diploma or GED

Associate degree or equivalent program

Certified Pharmacy Technician (PTCB)

Tools

CPR+ system

Job description

Onco360 is seeking a Pharmacy Claims Adjudication Specialist in Houston, TX. This full-time role requires adjudicating pharmacy claims, resolving third-party rejections, and communicating with patients regarding insurance issues.

The position offers hybrid work, a starting wage of $21 per hour, and a $5,000 sign-on bonus for hires before year-end 2026. Responsibilities include CNN: handling CPR+ system entries, ensuring accurate patient demographics and coverage, and collaborating with the