Onco360
Join to apply for the Pharmacy Claims Adjudication Specialist role at Onco360 Oncology Pharmacy .
We are seeking a Pharmacy Adjudication Specialist at our specialty pharmacy in Scottsdale, AZ . This is a full-time position. This position must be located within driving distance to our pharmacy, with a hybrid work style.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve community, oncology, and hematology physicians, patients, payers, and manufacturers.
Starting salary from $20.00 an hour and up
We offer a variety of benefits including:
- Medical, Dental, Vision
- 401k with a match
- Paid Time Off and Holidays
- Tuition Reimbursement
- Company paid benefits life, short and long-term disability
Major Responsibilities:
- Adjudicate pharmacy claims and review responses for accuracy.
- Ensure prescriptions are adjudicated correctly according to benefits coordination.
- Resolve third-party rejections, obtain overrides when appropriate.
- Notify patients of delays due to insurance rejections.
At Onco360, pharmacy adjudication specialists:
- Practice first call resolution to assist healthcare providers and patients.
- Provide accurate responses regarding active claims.
- Ensure complete patient setup in CPR+ system.
- Adjudicate claims for primary, secondary, and tertiary plans.
- Contact insurance companies to resolve rejections.
- Manage copay applications and funding adjudications.
- Assist with electronically adjudicated claims and patient outreach regarding financial responsibilities.
- Document and process patient refunds when needed.
Qualifications:
- High School Diploma or GED required; experience in pharmacy, medical billing, or benefits verification preferred.
- 1+ years experience in pharmacy/healthcare setting required; 3+ years preferred.
- Knowledge of pharmacy billing, claims resolution, insurance plans, and pharmacy terminology required.
- Registered with the Board of Pharmacy as per state law; Certified Pharmacy Technician preferred.
Behavioral Skills:
- Independent worker with good interpersonal and communication skills.
- Detail-oriented, time-efficient, flexible, and able to meet deadlines.
Additional Details:
- Seniority level: Entry level
- Employment type: Full-time
- Job function: Healthcare Provider
- Industry: Pharmaceutical Manufacturing
#J-18808-Ljbffr