Pharmacy Claims Adjudication Specialist

Onco360 Oncology Pharmacy; Indianapolis (IN); Remote; USD 28,000 - 40,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k with match

Paid time off

Paid holidays

Tuition reimbursement

Life insurance

Short-term disability

Long-term disability

Job summary

Onco360 Oncology Pharmacy in the United States is seeking a Pharmacy Adjudication Specialist for our specialty oncology operations. This full-time role may work remotely but requires active Indiana Pharmacy Technician credentials.

Starting salary is $25.00 per hour with a $5,000 sign-on bonus for hires starting before December 31, 2026. Benefits include medical/dental/vision, 401k, PTO, tuition reimbursement, and disability coverage.

Qualifications

• 2+ years experience in Pharmacy/Healthcare or pharmacy claims.
• High School Diploma or GED required.
• Pharmacy Technician license/registration as required by state law.
• Desired: Associate degree or equivalent and Specialty pharmacy experience.

Responsibilities

• First call resolution to help providers and patients with pharmacy needs.
• Provide accurate responses to requests regarding active claims.
• Ensure patientSetup in CPR+ with demographics and insurance info.
• Adjudicate claims for primary/secondary/tertiary plans; verify accuracy.
• Contact insurers to resolve third-party rejections and avoid shipment delays.
• Apply copay cards only for eligible patients; no Government beneficiaries eligibility.
• Coordinate funding adjudications and liaise with Onco360 Advocate team.
• Assist with adjudicated claims; ensure delivery assessments and copay payments before shipment.
• Serve as customer service liaison regarding financial responsibility prior to shipments.
• Document and submit requests for Patient Refunds when appropriate.
• Maintain a safe, clean pharmacy and comply with laws and confidentiality.
• Contribute to team effort and perform other duties as assigned.

Skills

Pharmacy billing

NDC medication billing

Claims resolution

Medicare knowledge

Medicaid knowledge

PBM contracts

Insurance knowledge

NCPDP rejection resolution

Coordination of benefits

Pharmacy terminology

Sig codes

Roman numerals

Brand vs generic names

Math skills

Typing skills

Education

High School Diploma or GED

Associate degree or equivalent program

Certified Pharmacy Technician

Tools

CPR+ system

Job description

W e are seeking a Pharmacy Adjudication Specialist for our Specialty Oncology pharmacy.

As our company continues to grow, we strive to hire new team members with a passion for making a difference in our patient's lives.

Full-Time position may work remotely but MUST HAVE ACTIVE INDIANA PHARMACY TECHNICIAN credentials from the State Board of Pharmacy.

Shift times between 8am and 8pm.

Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.

Starting salary from $25.00 an hour and up

Sign-On Bonus: $5,000 for employees starting before December 31st, 2026.

We offer a variety of benefits including:

• Medical; Dental; Vision
• 401k with a match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Company paid benefits – life; and short and long-term disability

Pharmacy Adjudication Specialist Major Responsibilities:

• Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
• Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
• Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
• Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
• Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
• Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
• Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
• Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
• Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
• Documents and submit requests for Patient Refunds when appropriate.
• Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
• Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Pharmacy Adjudication Specialist Qualifications And Responsibilities...

• Education/Learning Experience
  • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
  • Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
• Work Experience
  • Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
  • Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
• Skills/Knowledge
  • Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
  • Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
• Licenses/Certifications
  • Required: Pharmacy Technician License/Registration with Board of Pharmacy as required by state law
• Behavior Competencies
  • Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills