Lead, Oncology Pharmacy Claims Adjudication

Onco360; Buffalo (NY); On-site; USD 54,000 - 66,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401k with match

Paid Time Off & Holidays

Quarterly Incentive Bonuses

Tuition Reimbursement

Company paid life insurance & short/lt

Job summary

Onco360 Pharmacy is seeking a Pharmacy Adjudication Supervisor to lead the claims adjudication team and ensure accurate billing across primary, secondary, and tertiary plans. You will resolve third-party rejections, manage workflow, and drive process improvements to support timely medication delivery.

The role requires 4+ years in pharmacy adjudication with leadership experience, strong knowledge of payer contracts, and excellent communication with payers and patients.

Qualifications

• Required: High School Diploma or GED; experience in Pharmacy, Medical Billing, or Benefits Verification
• Desired: Associates or Bachelor's Degree; Certified Pharmacy Technician; Specialty pharmacy experience

Responsibilities

• Supervise adjudication staff and maintain positive environment; ensure effective cross-team communication
• Assist Director in day-to-day pharmacy operations and implementing new procedures
• Recruit, hire, orientate, develop, and train new associates; evaluate and coach staff
• Manage and report daily activity of team members and monitor workflow
• Handle escalations for complex claim rejection resolutions to ensure timely adjudication
• Adjudicate claims for active prescriptions across primary, secondary and tertiary plans
• Contact insurance companies to resolve third-party rejections and reschedule deliveries when needed
• Follow up on prior authorization requests and document information in patient profiles
• Collaborate with Pharmacy Ops on other initiatives and ensure quality service delivery
• Maintain compliance with laws, policies, and ethics while protecting patient confidentiality

Skills

NDC medication billing

PBM & medical contracts

Healthcare audit experience

Medicare, Medicaid & commercial"

NCPDP claim rejection resolution

Coordination of benefits

Pharmacy terminology

Sig codes & Roman numerals

Brand/generic names of medications

Advanced typing & math

Education

High School Diploma or GED

Associates or Bachelor's Degree

Job description

Onco360 Pharmacy is seeking a Pharmacy Adjudication Supervisor to lead the claims adjudication team and ensure accurate billing across primary, secondary, and tertiary plans. You will resolve third-party rejections, manage workflow, and drive process improvements to support timely medication delivery.

The role requires 4+ years in pharmacy adjudication with leadership experience, strong knowledge of payer contracts, and excellent communication with payers and patients.