Senior Pharmacy Claims Adjudication Lead

Onco360; Woodridge (IL); On-site; USD 54,000 - 66,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401k with match

PTO and Holidays

Quarterly incentive bonuses

Tuition reimbursement

Life insurance

Short/long-term disability

Job summary

Onco360 Pharmacy is seeking a Pharmacy Adjudication Supervisor to lead our adjudication team and ensure accurate claims processing for our specialty oncology program. The role includes resolving third-party rejections, coordinating benefits, and maintaining timely medication shipments.

The ideal candidate has 4+ years in pharmacy adjudication with leadership experience, knowledge of Medicare/Medicaid and PBM contracts, and strong analytical skills.

Qualifications

• Required: 4+ years in pharmacy adjudication or equivalent, with leadership experience.
• Knowledge of insurance regulations and third-party claims resolutions.
• Familiarity with NCPDP claim rejection resolution and coordination of benefits.

Responsibilities

• Oversee adjudication staff and maintain a positive team environment.
• Improve accuracy and timeliness of pharmacy claims processing.
• Resolve third-party rejections and reschedule shipments as needed to meet ship dates.
• Coordinate with insurance companies on prior authorizations and claims status.
• Mentor staff and implement new procedures with leadership input.

Skills

NDC billing

PBM contracts

Healthcare audits

Medicare/Medicaid knowledge

Pharmacy terminology

Interpersonal skills

Leadership

Analytical skills

Education

Associates or Bachelor's Degree

High School Diploma or GED

Job description

Onco360 Pharmacy is seeking a Pharmacy Adjudication Supervisor to lead our adjudication team and ensure accurate claims processing for our specialty oncology program. The role includes resolving third-party rejections, coordinating benefits, and maintaining timely medication shipments.

The ideal candidate has 4+ years in pharmacy adjudication with leadership experience, knowledge of Medicare/Medicaid and PBM contracts, and strong analytical skills.