Hybrid Pharmacy Claims Adjudication Specialist

Onco360 Oncology Pharmacy; Waltham (MA); Hybrid; USD 30,000 - 42,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401k with match

PTO & Holidays

Tuition reimbursement

Life insurance

Disability insurance

Job summary

Onco360 Oncology Pharmacy is seeking a Pharmacy Adjudication Specialist in Waltham, MA for a full-time, hybrid role. The position focuses on adjudicating pharmacy claims, resolving third-party rejections, and coordinating benefits to ensure timely medication delivery.

Ideal candidates have 2+ years in a Pharmacy/Healthcare setting, knowledge of Medicare/Medicaid, and experience with CPR+ or similar systems. A sign-on bonus is offered for eligible hires.

Qualifications

• Required: High School Diploma or GED; experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication.
• Desired: Associate degree or equivalent program; Certified Pharmacy Technician; Specialty pharmacy experience.

Responsibilities

• Adjudicate pharmacy claims and review claim responses for accuracy.
• Resolve third-party rejections and obtain overrides when appropriate.
• Contact insurance companies to resolve rejections and ensure on-time medication shipments.
• Communicate with patients/providers regarding copay discrepancies and payment collection.
• Maintain patient setup in CPR+ with demographics and insurance information.
• Ensure compliance with privacy laws and company standards.

Skills

Pharmacy claims adjudication

Claims resolution

NCPDP claim rejection resolution

Coordination of benefits

Medicare/Medicaid knowledge

Pharmacy terminology

Basic math & analytical skills

Typing/keyboard skills

Education

High School Diploma or GED

Associate degree or equivalent program

Certified Pharmacy Technician (PTCB)

Specialty pharmacy experience

Tools

CPR+ system

Job description

Onco360 Oncology Pharmacy is seeking a Pharmacy Adjudication Specialist in Waltham, MA for a full-time, hybrid role. The position focuses on adjudicating pharmacy claims, resolving third-party rejections, and coordinating benefits to ensure timely medication delivery.

Ideal candidates have 2+ years in a Pharmacy/Healthcare setting, knowledge of Medicare/Medicaid, and experience with CPR+ or similar systems. A sign-on bonus is offered for eligible hires.