Remote Pharmacy Claims Adjudication Specialist (VT)

Onco360; Burlington (VT); Hybrid; USD 52,000 - 72,000; Full time

Benefits offered by this job

401k with match

Paid Time Off

Paid Holidays

Tuition Reimbursement

Life insurance

Short and long-term disability

Job summary

Onco360 in Burlington, VT is seeking a Pharmacy Claims Adjudication Specialist to adjudicate pharmacy claims and review responses for accuracy within coordination of benefits. You will resolve third-party rejections, obtain overrides as appropriate, and notify patients about delays due to insurance issues while supporting timely medication delivery.

This full-time role may work remotely but requires Vermont Pharmacy Technician credentials; benefits include 401k match, PTO, tuition reimbursement,

Qualifications

• 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
• Required: 2+ years experience in Pharmacy/Healthcare Setting orpharmacy claims experience
• Desired: 3+ yearsexperience in Pharmacy/Healthcare Setting orpharmacy claims experience
• Required: Pharmacy Technician License/Registration with Board of Pharmacy as required by state law

Responsibilities

• Adjudicate pharmacy claims, review claim responses for accuracy and manage coordination of benefits
• Resolve third-party rejections and obtain overrides when appropriate
• Notify patients regarding delays in medication delivery due to insurance claim rejections
• Ensure complete and accurate patient setup in CPR+ system including demographics and insurance information
• Communicate with insurers to resolve rejections and reschedule deliveries as needed
• Apply copay cards only to eligible patients and manage funding adjudications
• Serve as customer service liaison to patients regarding financial responsibility prior to shipments
• Document and submit requests for Patient Refunds and maintain compliance with laws and policies

Skills

Pharmacy/NDC billing

Claims resolution

PBM & medical contracts

Medicare/Medicaid/Commercial insurance

NCPDP rejection resolution

Coordination of benefits

Pharmacy terminology (sig codes, Roman

Brand/generic names

Math & analytical skills

Typing/keyboard skills

Education

High School Diploma or GED

Associate degree or equivalent program

Certified Pharmacy Technician

Tools

CPR+ system

Job description

Onco360 in Burlington, VT is seeking a Pharmacy Claims Adjudication Specialist to adjudicate pharmacy claims and review responses for accuracy within coordination of benefits. You will resolve third-party rejections, obtain overrides as appropriate, and notify patients about delays due to insurance issues while supporting timely medication delivery.

This full-time role may work remotely but requires Vermont Pharmacy Technician credentials; benefits include 401k match, PTO, tuition reimbursement,