Hybrid Pharmacy Claims Adjudication Specialist

Onco360; Waltham (MA); Hybrid; USD 49,000 - 59,000; Full time

Benefits offered by this job

401k with match

Paid Time Off and Paid Holidays

Tuition Reimbursement

Company paid life and disability

Job summary

Onco360 in Waltham, MA is hiring a Pharmacy Claims Adjudication Specialist for a full-time hybrid role. You will adjudicate pharmacy claims, review responses for accuracy, and resolve third-party rejections to keep medications flowing to patients.

You will interact with providers, payers, and patients, ensuring proper data in CPR+ and proactive outreach when delays occur. Strong pharmacy billing knowledge is essential.

Qualifications

• High School Diploma or GED required; pharmacy or billing background preferred.
• Experience with pharmacy claims adjudication and third-party rejections.
• Knowledge of Medicare/Medicaid and commercial insurance basics.

Responsibilities

• Adjudicate pharmacy claims and review responses for accuracy.
• Resolve third-party rejections and obtain overrides when appropriate.
• Notify patients about delays due to insurance issues and coordinate shipments.
• Maintain patient setup accuracy in CPR+ with demographic and insurance data.
• Serve as liaison to providers, payers, and patients for active claims.

Skills

Pharmacy claims adjudication

PBM knowledge

Medicare/Medicaid knowledge

NCPDP codes

Communication skills

Detail orientation

Education

High School Diploma or GED

Associate degree or equivalent program

Certified Pharmacy Technician

Tools

CPR+ system

Job description

Onco360 in Waltham, MA is hiring a Pharmacy Claims Adjudication Specialist for a full-time hybrid role. You will adjudicate pharmacy claims, review responses for accuracy, and resolve third-party rejections to keep medications flowing to patients.

You will interact with providers, payers, and patients, ensuring proper data in CPR+ and proactive outreach when delays occur. Strong pharmacy billing knowledge is essential.