Pharmacy Claims Adjudication Specialist

Onco360; St. Louis (MO); Hybrid; USD 52,000 - 62,000; Full time

Benefits offered by this job

401k with match

Paid Time Off and Holidays

Tuition Reimbursement

Company paid life and disability

Job summary

Onco360 is seeking a Pharmacy Claims Adjudication Specialist in the St. Louis area. The role involves adjudicating pharmacy claims, confirming claim accuracy, and resolving third-party rejections to ensure timely medication delivery.

Some remote work may be possible with Missouri Pharmacy Technician credentials. The position offers a sign-on bonus, benefits, and a starting hourly wage of $25.00+. Responsibilities include patient communications, copay management, and coordination with insurance

Qualifications

• Requires high school diploma or GED.
• Experience in Pharmacy, Medical Billing, or Benefits Verification preferred.
• Strong attention to detail and accuracy in claim adjudication.

Responsibilities

• Adjudicate pharmacy claims and review responses for accuracy.
• Resolve third-party rejections and obtain overrides when appropriate.
• Contact insurers to resolve rejections and notify patients about delays.
• Support patient outreach regarding copay and medication delivery timing.
• Maintain patient privacy and adhere to compliance rules.

Skills

First-call resolution

Customer service liaison

Pharmacy claims adjudication

Insurance claim research

CPR+ system

Education

High School Diploma or GED

Tools

CPR+

Job description

Position:Pharmacy Claims Adjudication Specialist

Location: St. Louis, MO

Job Id:5785

# of Openings:1

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 MISSOURI 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:

• 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:

The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections

Pharmacy Adjudication Specialists at Onco360...

• 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 … etc.
• Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.

Pharmacy Adjudication Specialist Qualifications and Responsibilities...

• Education/Learning Experience
  • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification