Hybrid/Remote Pharmacy Claims Adjudication Specialist

Onco360 Oncology Pharmacy; Denver (CO); Hybrid; USD 33,000 - 41,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401k with match

Paid Time Off and Holidays

Tuition Reimbursement

Life Insurance

Disability Insurance

Job summary

Onco360 Pharmacy is seeking a Pharmacy Adjudication Specialist to adjudicate claims, resolve third-party rejections, and ensure accurate patient insurance data in CPR+.

The role supports timely medication delivery in a remote/hybrid setting, with shift hours starting at 10am MT and requires Colorado pharmacy credentials. Beginning hourly pay is $24+, with a $5,000 sign-on bonus for qualifying hires.

Qualifications

• Requires High School diploma or GED with pharmacy/claims experience.
• Prefer an Associate degree or equivalent and PTCB certification.
• Experience with pharmacy claims adjudication and CPT/HCPCS/NDC terminology.

Responsibilities

• Adjudicate pharmacy claims and review responses for accuracy.
• Resolve third-party rejections and obtain overrides when appropriate.
• Contact insurers to resolve claim issues and notify patients of delays.
• Ensure patient setup and insurance data accuracy in CPR+.
• Support timely shipping and copay collection prior to shipment.
• Serve as liaison to patients/providers on financial responsibility.
• Maintain compliance with regulations and company policies.
• Document requests for Patient Refunds when needed.

Skills

Pharmacy/nDC billing

Pharmacy claims resolution

Medicare/Medicaid knowledge

NCPDP rejection resolution

Coordination of benefits

Pharmacy terminology

Basic math & analytics

Typing/keyboard skills

Education

High School Diploma or GED

Associate degree or equivalent

Certified Pharmacy Technician

Job description

Onco360 Pharmacy is seeking a Pharmacy Adjudication Specialist to adjudicate claims, resolve third-party rejections, and ensure accurate patient insurance data in CPR+.

The role supports timely medication delivery in a remote/hybrid setting, with shift hours starting at 10am MT and requires Colorado pharmacy credentials. Beginning hourly pay is $24+, with a $5,000 sign-on bonus for qualifying hires.