Remote Oncology Pharmacy Claims Adjudication Specialist

TQC Ltd; Denver (CO); Hybride; USD 33 000 - 39 000; Plein temps

Avantages offerts par ce poste

Medical, Dental, Vision

401k with match

PTO and Holidays

Tuition Reimbursement

Company paid life and disability

Résumé du poste

Onco360 Pharmacy in the Mountain Time Zone is seeking a Pharmacy Adjudication Specialist for a full-time remote/hybrid role. The position requires active Colorado Pharmacy Technician credentials and offers starting pay of $24.00 per hour, plus a $5,000 sign-on bonus for hires before August 31, 2026.

Key duties include adjudicating pharmacy claims, resolving third-party rejections, ensuring COB accuracy, and communicating delays to patients to support timely delivery.

Qualifications

• 2+ years experience in Pharmacy/Healthcare or pharmacy claims
• Pharmacy claims adjudication and COB knowledge
• Knowledge of Medicare/Medicaid and commercial insurance
• Ability to resolve third-party rejections
• Attention to detail and data accuracy

Responsabilités

• Adjudicate pharmacy claims for active workflows
• Resolve third-party rejections and obtain overrides
• Ensure accurate patient setup in CPR+ system
• Communicate delays to patients/providers regarding claims
• Support timely shipment and COB application

Connaissances

Pharmacy claims adjudication

Coordination of benefits

NCPDP claim resolution

Medicare/Medicaid/Commercial insurance

PBM contracts knowledge

Pharmacy terminology & dosages

CPR+ data entry

Customer service mindset

Formation

High School Diploma or GED

Certified Pharmacy Technician (PTCB)

Description du poste

Onco360 Pharmacy in the Mountain Time Zone is seeking a Pharmacy Adjudication Specialist for a full-time remote/hybrid role. The position requires active Colorado Pharmacy Technician credentials and offers starting pay of $24.00 per hour, plus a $5,000 sign-on bonus for hires before August 31, 2026.

Key duties include adjudicating pharmacy claims, resolving third-party rejections, ensuring COB accuracy, and communicating delays to patients to support timely delivery.