Remote Pharmacy Claims Adjudication Specialist (NM Tech)

New England Air Systems, LLC; Albuquerque (NM); Hybrid; USD 25,000 - 36,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401k match

PTO & Holidays

Tuition Reimbursement

Life Insurance

Short/Long-term Disability

Job summary

Onco360 Pharmacy is seeking a Pharmacy Adjudication Specialist to adjudicate pharmacy claims and manage third-party rejections in a remote/hybrid capacity. The role requires coordination of benefits, patient outreach, and accurate CPR+ data entry.

Starting pay is $22.00 per hour with a $5,000 sign-on bonus for qualifying hires before Aug 31, 2026. Ideal candidates will have NM Pharmacy Technician credentials, 2+ years in pharmacy or claims, and strong knowledge of Medicare/Medicaid, PBM

Qualifications

• Requires HS diploma or GED; pharmacy/claims experience preferred
• Desirable: Associate degree or tech cert (PTCB)

Responsibilities

• Adjudicate pharmacy claims for primary, secondary, and tertiary plans.
• Review claim responses for accuracy before accepting the claim.
• Contact insurance companies to resolve third-party rejections.
• Perform outreach to patients/providers regarding delays and copay differences.
• Ensure patient setup with correct demographics and insurance data.

Skills

Pharmacy billing

Claims adjudication

Coordination of benefits

Medicare/Medicaid knowledge

NCPDP rejection resolution

Customer service

Data entry CPR+

Communication skills

Education

High School Diploma or GED

Certified Pharmacy Technician

Tools

CPR+ system

Job description

Onco360 Pharmacy is seeking a Pharmacy Adjudication Specialist to adjudicate pharmacy claims and manage third-party rejections in a remote/hybrid capacity. The role requires coordination of benefits, patient outreach, and accurate CPR+ data entry.

Starting pay is $22.00 per hour with a $5,000 sign-on bonus for qualifying hires before Aug 31, 2026. Ideal candidates will have NM Pharmacy Technician credentials, 2+ years in pharmacy or claims, and strong knowledge of Medicare/Medicaid, PBM