Onco360 Oncology Pharmacy
Pharmacy Claims Adjudication Specialist
Onco360 Oncology Pharmacy, Scottsdale, Arizona, us, 85261
Pharmacy Claims Adjudication Specialist
– Onco360 Oncology Pharmacy
We are seeking a Pharmacy Adjudication Specialist at our specialty pharmacy in Scottsdale, AZ. This is a full‑time position with a remote hybrid opportunity after an onsite training period.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology, and hematology physicians, patients, payers, and manufacturers.
Starting salary from $23.00 an hour and up. Sign‑On Bonus: $5,000 for employees starting before February 1, 2026.
Seniority level: Entry level.
Employment type: Full-time.
Job function: Healthcare Provider; Industry: Pharmaceutical Manufacturing.
Benefits
Medical; Dental; Vision
401(k) with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Life Insurance
Short‑ and long‑term disability
Responsibilities
Adjudicate pharmacy claims, review claim responses for accuracy, ensure prescription claims are adjudicated correctly according to the coordination of benefits.
Resolve third‑party rejections, obtain overrides if appropriate.
Perform patient outreach for claims delays and coordinate medication delivery.
Handle first‑call resolution for healthcare providers and patients, answering pharmacy related questions.
Ensure complete and accurate patient setup in CPR+ system (demographics, insurance).
Contact insurance companies to resolve rejections and facilitate timely shipment of medications.
Verify copay card eligibility and manage funding adjudications.
Coordinate electronically adjudicated claims, reconcile prescription assessments, and charge copay payments prior to shipment.
Serve as customer service liaison for financial responsibility, communicate copay discrepancies, collect payments.
Document and submit patient refund requests when appropriate.
Qualifications
Education / Learning Experience
Required: High School Diploma or GED; prior experience in pharmacy, medical billing, benefit verification, or pharmacy claims adjudication.
Desired: Associate degree or equivalent; Certified Pharmacy Technician; specialty pharmacy experience.
Work Experience
Required: 1+ years in pharmacy/healthcare setting or pharmacy claims experience.
Desired: 3+ years in similar role.
Skills / Knowledge
Required: Pharmacy/NDC medication billing, pharmacy claims resolution, PBM and medical contracts, Medicare, Medicaid, commercial insurance knowledge, NCPDP claim rejection resolution, coordination of benefits, pharmacy terminology, basic math, intermediate typing/keyboarding.
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
Independent worker, good interpersonal skills, excellent verbal and written communication.
Efficiently meeting deadlines, flexibility, detail‑oriented, great time‑management.
Company Values Teamwork, Respect, Integrity, Passion
#J-18808-Ljbffr
– Onco360 Oncology Pharmacy
We are seeking a Pharmacy Adjudication Specialist at our specialty pharmacy in Scottsdale, AZ. This is a full‑time position with a remote hybrid opportunity after an onsite training period.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology, and hematology physicians, patients, payers, and manufacturers.
Starting salary from $23.00 an hour and up. Sign‑On Bonus: $5,000 for employees starting before February 1, 2026.
Seniority level: Entry level.
Employment type: Full-time.
Job function: Healthcare Provider; Industry: Pharmaceutical Manufacturing.
Benefits
Medical; Dental; Vision
401(k) with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Life Insurance
Short‑ and long‑term disability
Responsibilities
Adjudicate pharmacy claims, review claim responses for accuracy, ensure prescription claims are adjudicated correctly according to the coordination of benefits.
Resolve third‑party rejections, obtain overrides if appropriate.
Perform patient outreach for claims delays and coordinate medication delivery.
Handle first‑call resolution for healthcare providers and patients, answering pharmacy related questions.
Ensure complete and accurate patient setup in CPR+ system (demographics, insurance).
Contact insurance companies to resolve rejections and facilitate timely shipment of medications.
Verify copay card eligibility and manage funding adjudications.
Coordinate electronically adjudicated claims, reconcile prescription assessments, and charge copay payments prior to shipment.
Serve as customer service liaison for financial responsibility, communicate copay discrepancies, collect payments.
Document and submit patient refund requests when appropriate.
Qualifications
Education / Learning Experience
Required: High School Diploma or GED; prior experience in pharmacy, medical billing, benefit verification, or pharmacy claims adjudication.
Desired: Associate degree or equivalent; Certified Pharmacy Technician; specialty pharmacy experience.
Work Experience
Required: 1+ years in pharmacy/healthcare setting or pharmacy claims experience.
Desired: 3+ years in similar role.
Skills / Knowledge
Required: Pharmacy/NDC medication billing, pharmacy claims resolution, PBM and medical contracts, Medicare, Medicaid, commercial insurance knowledge, NCPDP claim rejection resolution, coordination of benefits, pharmacy terminology, basic math, intermediate typing/keyboarding.
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
Independent worker, good interpersonal skills, excellent verbal and written communication.
Efficiently meeting deadlines, flexibility, detail‑oriented, great time‑management.
Company Values Teamwork, Respect, Integrity, Passion
#J-18808-Ljbffr