Remote Pharmacy Claims Adjudication Specialist

Onco360 Oncology Pharmacy; Reno (NV); Hybrid; USD 47,000 - 60,000; Full time

Benefits offered by this job

401k with match

Paid Time Off and Paid Holidays

Tuition Reimbursement

Company paid benefits - life; and long

Job summary

Onco360 Pharmacy is seeking a Pharmacy Claims Adjudication Specialist to adjudicate pharmacy claims, review claim responses for accuracy, and manage coordination of benefits. The role includes resolving third-party rejections, providing patient outreach, and ensuring CPR+ system data integrity.

The position is remote/hybrid with Utah licensure requirements; starting hourly rate is $23+ with a $5,000 sign-on bonus for eligible hires.

Qualifications

• Education/Learning Experience: Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
• Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
• Work Experience: Required: 2+ years experience in Pharmacy/Healthcare Setting orpharmacy claims experience
• Desired: 3+ yearsexperience in Pharmacy/Healthcare Setting orpharmacy claims experience
• Skills/Knowledge: Required:Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
• Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
• Licenses/Certifications: Required:Registration with Board of Pharmacy as required by state law
• Desired:Certified Pharmacy Technician (PTCB)
• 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

Responsibilities

• Adjudicate pharmacy claims, review claim responses for accuracy.
• Ensure claims are adjudicated according to coordination of benefits.
• Resolve third-party rejections and obtain overrides when appropriate.
• Notify patients about delays due to insurance claim issues.
• Provide first-call resolution to health care providers and patients.
• Ensure patient setup in CPR+ with demographic/insurance data.
• Communicate with insurers to resolve rejections and reschedule shipments if needed.
• Apply copay cards only to eligible patients.
• Maintain compliance with company policies and privacy laws.
• Support team and perform related duties.

Skills

Pharmacy claims adjudication

Coordination of benefits

PBM knowledge

Medicare/Medicaid knowledge

NCPDP claim rejection resolution

Pharmacy terminology & codes

Analytical skills

Customer service

Education

High School Diploma or GED

Associate degree

Certified Pharmacy Technician

Tools

CPR+ system

Pharmacy billing systems

Job description

Onco360 Pharmacy is seeking a Pharmacy Claims Adjudication Specialist to adjudicate pharmacy claims, review claim responses for accuracy, and manage coordination of benefits. The role includes resolving third-party rejections, providing patient outreach, and ensuring CPR+ system data integrity.

The position is remote/hybrid with Utah licensure requirements; starting hourly rate is $23+ with a $5,000 sign-on bonus for eligible hires.