Remote Pharmacy Claims Adjudication Specialist

Onco360 Oncology Pharmacy

Reno (NV)

Hybrid

USD 47,000 - 60,000

Full time

14 days+

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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.