Senior Pharmacy Adjudication Lead

Onco360 Oncology Pharmacy; Houston (TX); On-site; USD 54,000 - 66,000; Full time

Job summary

Onco360 Pharmacy is seeking a Pharmacy Adjudication Supervisor to lead the adjudication team, ensure accuracy of pharmacy claims, and resolve third-party rejections to support timely medication delivery.

The role requires strong leadership, collaboration with pharmacy operations, and hands-on management of daily workflow; a 60k+ salary with a 5k sign-on bonus and a robust benefits package are offered.

Qualifications

• Required: High School Diploma or GED; experience in Pharmacy, Medical Billing or Benefits Verification and knowledge of insurance regulations.
• Preferred: Associates or Bachelor's degree; Certified Pharmacy Technician; specialty pharmacy experience.

Responsibilities

• Supervises adjudication staff and maintains positive working environment.
• Assist Director in day-to-day operations and implement new procedures for accurate dispensing.
• Recruit, hire, train, coach, and evaluate staff; deliver corrective action as needed.
• Manage daily activity and workflow; handle escalations for claim rejection resolution.
• Adjudicate pharmacy claims and review claim responses for accuracy.
• Contact insurers to resolve third-party rejections and reschedule deliveries when needed.
• Follow up on prior authorizations and document information in patient profiles.

Skills

NDC billing

PBM contracts

Medicare knowledge

Medicaid knowledge

Benefits verification

Education

High School Diploma or GED

Associates or Bachelor's degree

Certified Pharmacy Technician

Job description

Onco360 Pharmacy is seeking a Pharmacy Adjudication Supervisor to lead the adjudication team, ensure accuracy of pharmacy claims, and resolve third-party rejections to support timely medication delivery.

The role requires strong leadership, collaboration with pharmacy operations, and hands-on management of daily workflow; a 60k+ salary with a 5k sign-on bonus and a robust benefits package are offered.