Remote Oncology Pharmacy Claims Adjudication Specialist

Onco360 Oncology Pharmacy; Burlington (VT); A distancia; USD 28.000 - 40.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical

Dental

Vision

401k with match

PTO and Holidays

Tuition Reimbursement

Company paid life and disability

Descripción de la vacante

Onco360 Oncology Pharmacy seeks a Pharmacy Adjudication Specialist to adjudicate claims and manage payer responses. Remote option available but must hold Vermont Pharmacy Technician credentials.

You will resolve third-party rejections, coordinate benefits, and communicate with patients about coverage and delivery timing. The role requires 2+ years in pharmacy claims or healthcare claims, attention to detail, and strong communication.

Formación

• Experience in pharmacy claims adjudication and billing processes.
• Understanding of insurance formularies, COB, and claim types.
• Familiarity with CPR+ or similar pharmacy software is a plus.

Responsabilidades

• Adjudicate pharmacy claims and review responses for accuracy.
• Resolve third-party rejections and obtain overrides when needed.
• Notify patients regarding delays due to insurance issues.
• Maintain accurate patient setup and insurance data in the system.
• Communicate with insurers to resolve rejections and reschedule deliveries if needed.
• Discuss copay responsibilities with patients and collect payments when applicable.
• Document refunds and ensure compliance with laws and company policies.

Conocimientos

Pharmacy billing

Pharmacy claims resolution

Coordination of benefits

NCPDP claim rejection resolution

Medicare/Medicaid knowledge

Basic math & analytics

Typing / data entry

Educación

High School Diploma or GED

Associate degree or equivalent program

Certified Pharmacy Technician

Descripción del empleo

Onco360 Oncology Pharmacy seeks a Pharmacy Adjudication Specialist to adjudicate claims and manage payer responses. Remote option available but must hold Vermont Pharmacy Technician credentials.

You will resolve third-party rejections, coordinate benefits, and communicate with patients about coverage and delivery timing. The role requires 2+ years in pharmacy claims or healthcare claims, attention to detail, and strong communication.