Hybrid Pharmacy Claims Adjudication Specialist

Onco360 Oncology Pharmacy; Houston (TX); Hybrid; USD 24,000 - 34,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401k with a match

PTO and Holidays

Tuition Reimbursement

Company paid life and disability

Job summary

Onco360 Pharmacy in Houston, TX is hiring a Pharmacy Adjudication Specialist for a full-time hybrid role. Shift times range from 8am to 8pm, and the position requires being within driving distance to our pharmacy. Starting salary is $21.00 per hour with a $5,000 sign-on bonus for starts before December 31, 2026.

The role involves adjudicating claims and communicating with patients about insurance delays. Responsibilities include first-call resolution, ensuring accurate CPR+ patient data,

Qualifications

• High School Diploma or GED; 2+ years in pharmacy/healthcare or claims.
• Associate degree or equivalent and/or Certified Pharmacy Technician preferred.
• Strong knowledge of Medicare, Medicaid, and commercial insurance.

Responsibilities

• Adjudicates pharmacy claims for active workflows.
• Resolves third-party rejections and coordinates appeals.
• Contacts insurers to resolve rejections and notifies patients of delays.
• Ensures patient setup accuracy in CPR+.
• Provides timely responses to providers and patients regarding active claims information.
• Manages copay cards and payments prior to shipment.
• Maintains compliance with laws and company policies.

Skills

Pharmacy claims

Coordination of benefits

NCPDP claims

PBM contracts

Medicare/Medicaid

Basic math

Typing

Customer service

Education

High School Diploma or GED

Associate degree or equivalent

Certified Pharmacy Technician (PTCB)

Tools

CPR+ system

Job description

Onco360 Pharmacy in Houston, TX is hiring a Pharmacy Adjudication Specialist for a full-time hybrid role. Shift times range from 8am to 8pm, and the position requires being within driving distance to our pharmacy. Starting salary is $21.00 per hour with a $5,000 sign-on bonus for starts before December 31, 2026.

The role involves adjudicating claims and communicating with patients about insurance delays. Responsibilities include first-call resolution, ensuring accurate CPR+ patient data,