Remote Pharmacy Claims Adjudication Specialist

Onco360 Oncology Pharmacy; Albuquerque (NM); Hybrid; USD 25,000 - 36,000; Full time

Benefits offered by this job

401k with match

Paid Time Off

Tuition Reimbursement

Company paid life/disability

Job summary

Onco360 Oncology Pharmacy is seeking a Pharmacy Claims Adjudication Specialist in Albuquerque, NM. This full-time, remote/hybrid role requires NM Pharmacy Technician credentials and involves adjudicating claims, resolving third-party rejections, and communicating with patients and providers about insurance issues.

The position offers benefits including 401k match, PTO, tuition reimbursement, and company-paid life/disability insurance.

Qualifications

• High School Diploma or GED required.
• 2+ years in Pharmacy/Healthcare or pharmacy claims experience.
• Associate degree or technical certification preferred.
• Registration with Board of Pharmacy as required by state law.

Responsibilities

• Adjudicate pharmacy claims in active workflow across plans and review responses.
• Resolve third-party rejections and obtain overrides when appropriate.
• Communicate with patients/providers about claim status and delivery delays.
• Ensure accurate patient setup in CPR+ with demographics/insurance data.
• Coordinate with insurance to resolve COB issues and ensure timely shipments.

Skills

Pharmacy claims resolution

NDC medication billing

PBM contracts

Medicare/Medicaid knowledge

NCPDP rejection resolution

Coordination of benefits

Pharmacy terminology

Basic math

Typing skills

Education

High School Diploma or GED

Associate degree

Certified Pharmacy Technician

Job description

Onco360 Oncology Pharmacy is seeking a Pharmacy Claims Adjudication Specialist in Albuquerque, NM. This full-time, remote/hybrid role requires NM Pharmacy Technician credentials and involves adjudicating claims, resolving third-party rejections, and communicating with patients and providers about insurance issues.

The position offers benefits including 401k match, PTO, tuition reimbursement, and company-paid life/disability insurance.