Onco360 Oncology Pharmacy
Pharmacy Claims Adjudication Specialist
Onco360 Oncology Pharmacy, Louisville, Kentucky, us, 40201
Overview
Join to apply for the
Pharmacy Claims Adjudication Specialist
role at
Onco360 Oncology Pharmacy . Location: Louisville, KY. This is a Full-Time position with a hybrid work arrangement and must be located within driving distance to our pharmacy. Starting salary from
$20.00 an hour
and up. Benefits
Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits – life; and short and long-term disability Major responsibilities
Adjudicate pharmacy claims and review claim responses for accuracy according to the coordination of benefits. Resolve third-party rejections, obtain overrides if appropriate, and notify patients regarding delays in medication delivery due to insurance claim rejections. Practice first-call resolution to assist health care providers and patients with their pharmacy needs, answering questions and requests. Provide thorough, accurate, and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information. Ensure complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Adjudicate pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary plans and review claim responses for accuracy before accepting the claim. Contact insurance companies to resolve third-party rejections and perform outreach calls to patients or providers to reschedule deliveries if claim resolution cannot be completed by ship date. Ensure copay cards are only applied to claims for eligible patients based on criteria such as insurance type (government beneficiaries not eligible). Manage all funding related adjudications and act as a liaison to the Onco360 Advocate team. Assist the pharmacy team with management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment. Serve as a customer service liaison to patients regarding financial responsibility prior to shipments, including communicating any copay discrepancy and collecting payment if applicable. Document and submit requests for patient refunds when appropriate. Qualifications and Requirements
Education/Learning Experience
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
Work Experience
Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Skills/Knowledge
Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, intermediate typing Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
Licenses/Certifications
Required: Registration with Board of Pharmacy as required by state law Desired: Certified Pharmacy Technician (PTCB)
Behavior Competencies
Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills
Company Values
Teamwork, Respect, Integrity, Passion Seniority level
Entry level Employment type
Full-time Job function
Health Care Provider Industries
Pharmaceutical Manufacturing
#J-18808-Ljbffr
Join to apply for the
Pharmacy Claims Adjudication Specialist
role at
Onco360 Oncology Pharmacy . Location: Louisville, KY. This is a Full-Time position with a hybrid work arrangement and must be located within driving distance to our pharmacy. Starting salary from
$20.00 an hour
and up. Benefits
Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits – life; and short and long-term disability Major responsibilities
Adjudicate pharmacy claims and review claim responses for accuracy according to the coordination of benefits. Resolve third-party rejections, obtain overrides if appropriate, and notify patients regarding delays in medication delivery due to insurance claim rejections. Practice first-call resolution to assist health care providers and patients with their pharmacy needs, answering questions and requests. Provide thorough, accurate, and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information. Ensure complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Adjudicate pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary plans and review claim responses for accuracy before accepting the claim. Contact insurance companies to resolve third-party rejections and perform outreach calls to patients or providers to reschedule deliveries if claim resolution cannot be completed by ship date. Ensure copay cards are only applied to claims for eligible patients based on criteria such as insurance type (government beneficiaries not eligible). Manage all funding related adjudications and act as a liaison to the Onco360 Advocate team. Assist the pharmacy team with management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment. Serve as a customer service liaison to patients regarding financial responsibility prior to shipments, including communicating any copay discrepancy and collecting payment if applicable. Document and submit requests for patient refunds when appropriate. Qualifications and Requirements
Education/Learning Experience
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
Work Experience
Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Skills/Knowledge
Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, intermediate typing Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
Licenses/Certifications
Required: Registration with Board of Pharmacy as required by state law Desired: Certified Pharmacy Technician (PTCB)
Behavior Competencies
Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills
Company Values
Teamwork, Respect, Integrity, Passion Seniority level
Entry level Employment type
Full-time Job function
Health Care Provider Industries
Pharmaceutical Manufacturing
#J-18808-Ljbffr