Hybrid Pharmacy Claims Adjudication Specialist

Onco360 Oncology Pharmacy; Waltham (MA); Hybrid; USD 26,000 - 30,000; Full time

Benefits offered by this job

401(k) with match

Paid Time Off and Paid Holidays

Tuition Reimbursement

Company-paid benefits – life, short and long-term disability

Job summary

Onco360 Oncology Pharmacy in Waltham, MA, is seeking a Pharmacy Claims Adjudication Specialist to adjudicate pharmacy claims, resolve third-party rejections, and conduct patient outreach. The ideal candidate will have a high school diploma or GED, at least one year of experience in a pharmacy or healthcare setting, and strong knowledge of pharmacy medication billing and insurance processes. This role offers a hybrid work style along with comprehensive benefits including a 401(k) match and tuition reimbursement.

Qualifications

• High School Diploma or GED required, plus experience in pharmacy or claims adjudication.
• 1+ years of experience in pharmacy or healthcare setting required.
• Knowledge of pharmacy terminology and coordination of benefits is essential.

Responsibilities

• Adjudicate pharmacy claims and resolve third-party rejections.
• Conduct patient outreach regarding delays in medication deliveries.
• Respond to providers' and patients' inquiries as first-point resolution.

Skills

Pharmacy/NDC medication billing

Pharmacy claims resolution

Knowledge of Medicare and Medicaid

Basic math and analytical skills

Excellent communication skills

Education

High School Diploma or GED

Associate degree or equivalent

Job description

Onco360 Oncology Pharmacy in Waltham, MA, is seeking a Pharmacy Claims Adjudication Specialist to adjudicate pharmacy claims, resolve third-party rejections, and conduct patient outreach. The ideal candidate will have a high school diploma or GED, at least one year of experience in a pharmacy or healthcare setting, and strong knowledge of pharmacy medication billing and insurance processes. This role offers a hybrid work style along with comprehensive benefits including a 401(k) match and tuition reimbursement.