Hybrid Pharmacy Claims Adjudication Specialist

Onco360; Village of New Hyde Park (NY); Hybrid; USD 30,000 - 42,000; Full time

Benefits offered by this job

401k with match

Paid Time Off and Paid Holidays

Tuition Reimbursement

Company paid benefits - life; and long

Job summary

Onco360 is seeking a Pharmacy Claims Adjudication Specialist for hybrid work in New Hyde Park, NY. The role focuses on adjudicating pharmacy claims, resolving third-party rejections, and communicating with patients and providers about claim status.

The ideal candidate has 2+ years in pharmacy claims, strong COB and insurance knowledge, and experience with CPR+ systems. Eligible for benefits including 401(k), PTO, and tuition reimbursement.

Qualifications

• 2+ years experience in Pharmacy/Healthcare or pharmacy claims.
• Registration with Board of Pharmacy as required by state law.
• Experience with pharmacy billing and claims adjudication.

Responsibilities

• Adjudicate pharmacy claims in active workflow for primary, secondary, and tertiary plans.
• Review claim responses for accuracy before accepting the claim.
• Resolve third-party rejections and obtain overrides when appropriate.
• Contact insurance companies to resolve denials and delays.
• Assist patients with copay calculations and payment collection when applicable.
• Maintain patient information accuracy in CPR+ and CRM systems.

Skills

Pharmacy claims

Coordination of benefits

Medicare/Medicaid knowledge

NCPDP claim resolution

Analytical skills

Typing

Education

High School Diploma or GED

Associate degree or equivalent

Tools

CPR+ system

Job description

Onco360 is seeking a Pharmacy Claims Adjudication Specialist for hybrid work in New Hyde Park, NY. The role focuses on adjudicating pharmacy claims, resolving third-party rejections, and communicating with patients and providers about claim status.

The ideal candidate has 2+ years in pharmacy claims, strong COB and insurance knowledge, and experience with CPR+ systems. Eligible for benefits including 401(k), PTO, and tuition reimbursement.