Remote Oncology Pharmacy Claims Adjudication Pro

Onco360 Oncology Pharmacy; St. Louis (MO); Hybrid; USD 52,000 - 70,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401k with match

Paid Time Off and Paid Holidays

Tuition Reimbursement

Company paid life and disability

Job summary

Onco360 Oncology Pharmacy is seeking a Pharmacy Adjudication Specialist to adjudicate claims and manage insurance interactions. You will help ensure timely delivery and accurate patient billing, while supporting the pharmacy team in claims processing.

The role requires MO pharmacy technician credentials, and may be remote or hybrid with shifts 8am–8pm. Starting pay is $25/hour plus a $5,000 sign-on bonus for new hires before 12/31/2026.

Qualifications

• Education: High School Diploma or GED; experience in Pharmacy, Medical Billing, or Claims Adjudication.
• Desired: Associate degree or equivalent; Certified Pharmacy Technician; Specialty pharmacy experience.
• Work Experience: 2+ years in Pharmacy/Healthcare or claims experience; 3+ years preferred.
• Knowledge of Medicare/Medicaid/Commercial insurance and PBM contracts.

Responsibilities

• Adjudicate pharmacy claims and review claim responses for accuracy.
• Resolve third-party rejections and obtain overrides where appropriate.
• Notify patients about delays in medication delivery due to insurance issues.
• Ensure accurate patient setup in CPR+ including demographics and insurance.
• Contact insurers to resolve rejections and reschedule deliveries if needed.
• Apply copay cards only to eligible patients.
• Coordinate with Onco360 Advocate team on funding adjudications.
• Assist with management of electronically adjudicated claims and copay payments.
• Communicate copay discrepancies to patients and collect payments.
• Document and submit requests for Patient Refunds when appropriate.
• Maintain safety and confidentiality; comply with laws and ethics.

Skills

Pharmacy/NDC medication billing

Pharmacy claims resolution

PBM and Medical contracts

Medicare/Medicaid/Commercial insurance

NCPDP claim rejection resolution

Coordination of benefits

Pharmacy terminology (sig codes, Roman

Brand/generic names of medication

Basic math and analytical skills

Typing / keyboarding

Education

High School Diploma or GED

Associate degree or equivalent program

Certified Pharmacy Technician

Tools

CPR+ system

Job description

Onco360 Oncology Pharmacy is seeking a Pharmacy Adjudication Specialist to adjudicate claims and manage insurance interactions. You will help ensure timely delivery and accurate patient billing, while supporting the pharmacy team in claims processing.

The role requires MO pharmacy technician credentials, and may be remote or hybrid with shifts 8am–8pm. Starting pay is $25/hour plus a $5,000 sign-on bonus for new hires before 12/31/2026.