Pharmacy Claims Adjudication- Supervisor

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 has a need for qualified candidates to fill our role of Pharmacy Adjudication Supervisor. This is an excellent opportunity to join our company and help with our expanding Specialty Pharmacy program! This is a full-time position, Monday to Friday 10:30 am to 7:00 pm EST.

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

A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.

We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.

Salary range starting at $60k and up depending on experience

Sign-On Bonus: $5,000 for employees starting before October 31, 2026

We offer a variety of benefits including:

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

The Pharmacy Adjudication Supervisor is responsible for all aspects of pharmacy claims adjudication, accuracy of pharmacy claims, resolution of third-party rejections, coordination of benefits, and patient outreach regarding any delay in medication delivery due to insurance claim rejections. This role requires advanced program knowledge and will provide quality control by routinely examining cases completed by team members.

Adjudication Supervisor Essential Functions:

• Supervises adjudication staff in a leadership role to maintain a positive working environment by creating synergy and teamwork to minimize employee relations issues and reduce turnover. Communicates effectively across pharmacy and/or corporate teams and with patients, and successfully resolves issues.
• Assists Director of Pharmacy Operations in day-to-day pharmacy operations and in implementing new procedures to ensure that the accurate and timely dispensing of quality pharmacy services is consistently delivered to all patients using effective service leadership and customer skills.
• Works with pharmacy management to recruit, select, hire, orientate, develop, and train new associates. On an ongoing basis, evaluates, coaches, and utilizes performance management practices to motivate and set expectations for PA staff. In collaboration with management, drafts and delivers effective corrective action plans and disciplinary action to technicians performing at substandard levels.
• Manages and reports on daily activity of vertical team members, including monitoring of daily workflow and Pulse reporting.
• Handles escalations for difficult claim rejection resolution cases/questions to ensure accurate and timely completion of adjudication.
• 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.
• Contacts insurance companies to follow up on prior authorization requests, including determining if any additional information is needed, or whether the claim is in review, approved, or denied. Document all prior authorization information in patient profile.
• Works with Pharmacy Technician Manager and/or Director of Pharmacy Operations on other responsibilities, projects, implementations, and initiatives as needed.
• Maintains 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.

Adjudication Supervisor Qualifications:

Education/Learning Experience

• Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Knowledge of insurance and applicable regulations
• Desired: Associates or Bachelor's Degree, Certified Pharmacy Technician, Specialty pharmacy experience

Work Experience

• Required: 4+ years pharmacy or pharmacy adjudication or equivalent experience, previous leadership experience
• Desired: 5+ years pharmacy or pharmacy adjudication or equivalent experience, 1+ years supervisor experience, Specialty pharmacy experience

Skills/Knowledge

• Required: NDC medication billing, PBM and medical contracts, healthcare audit experience, knowledge of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, excellent interpersonal skills, able to work with all levels of management and staff, vast knowledge of pharmacy terminology and process including sig codes, and roman numerals, brand/generic names of medication, advanced typing, math and analytical skills.
• Desired: Specialty pharmacy operations, leadership skills, independent decision-making abilities, able to conduct research, be resourceful, and self-reliant, excellent communication skills

Licenses/Certifications

• Required: Registration with Board of Pharmacy as required by state law
• Desired: Certified Pharmacy Technician (PTCB), Advanced Certified Pharmacy Technician with completion of Billing and Reimbursement certification

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, leadership