Onco360 Oncology Pharmacy
Pharmacy Claims Adjudication Specialist
Onco360 Oncology Pharmacy, Louisville, Kentucky, us, 40201
Pharmacy Claims Adjudication Specialist
Onco360 Oncology Pharmacy is seeking a Pharmacy Claims Adjudication Specialist to work full‑time at our specialty pharmacy in Louisville, KY. The position requires a hybrid work style and must be located within driving distance of the pharmacy.
Starting salary from $20.00 an hour and up. Sign‑on bonus: $5,000 for employees starting before February 1, 2026.
Benefits include:
Medical, Dental, Vision
401k with match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Company‑paid life, short‑term and long‑term disability
Major Responsibilities
Adjudicate pharmacy claims and review claim responses for accuracy according to coordination of benefits.
Resolve third‑party rejections, obtain overrides when appropriate, and ensure timely shipment of medications.
Contact insurance companies to resolve rejections and perform outreach to patients or providers when claims cannot be resolved before ship date.
Apply copay cards only to eligible patients based on set criteria.
Manage all funding‑related adjudications and liaise with the Onco360 Advocate team.
Assist the pharmacy team with electronically adjudicated claims reconciliation and copay payment charging before shipment.
Serve as customer service liaison to patients regarding financial responsibility prior to shipments, and collect payment if needed.
Document and submit requests for patient refunds when appropriate.
Practice first‑call resolution to help health‑care providers and patients with their pharmacy needs, answering questions and requests.
Ensure complete and accurate patient setup in CPR+ system, including demographic and insurance information.
Qualifications
Education / Learning Experience
Required:
High School Diploma or GED. Prior experience in pharmacy, medical billing, benefits verification, or pharmacy claims adjudication.
Desired:
Associate degree or equivalent, Certified Pharmacy Technician, specialty pharmacy experience.
Work Experience
Required:
1+ years in a pharmacy or health‑care setting or pharmacy claims experience.
Desired:
3+ years in pharmacy or health‑care setting or pharmacy claims experience.
Skills / Knowledge
Required:
NDC medication billing, pharmacy claims resolution, PBM and medical contracts, understanding of Medicare, Medicaid, and commercial insurance, 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 the 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, ability to work independently and efficiently, 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. Industry: Pharmaceutical Manufacturing.
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Starting salary from $20.00 an hour and up. Sign‑on bonus: $5,000 for employees starting before February 1, 2026.
Benefits include:
Medical, Dental, Vision
401k with match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Company‑paid life, short‑term and long‑term disability
Major Responsibilities
Adjudicate pharmacy claims and review claim responses for accuracy according to coordination of benefits.
Resolve third‑party rejections, obtain overrides when appropriate, and ensure timely shipment of medications.
Contact insurance companies to resolve rejections and perform outreach to patients or providers when claims cannot be resolved before ship date.
Apply copay cards only to eligible patients based on set criteria.
Manage all funding‑related adjudications and liaise with the Onco360 Advocate team.
Assist the pharmacy team with electronically adjudicated claims reconciliation and copay payment charging before shipment.
Serve as customer service liaison to patients regarding financial responsibility prior to shipments, and collect payment if needed.
Document and submit requests for patient refunds when appropriate.
Practice first‑call resolution to help health‑care providers and patients with their pharmacy needs, answering questions and requests.
Ensure complete and accurate patient setup in CPR+ system, including demographic and insurance information.
Qualifications
Education / Learning Experience
Required:
High School Diploma or GED. Prior experience in pharmacy, medical billing, benefits verification, or pharmacy claims adjudication.
Desired:
Associate degree or equivalent, Certified Pharmacy Technician, specialty pharmacy experience.
Work Experience
Required:
1+ years in a pharmacy or health‑care setting or pharmacy claims experience.
Desired:
3+ years in pharmacy or health‑care setting or pharmacy claims experience.
Skills / Knowledge
Required:
NDC medication billing, pharmacy claims resolution, PBM and medical contracts, understanding of Medicare, Medicaid, and commercial insurance, 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 the 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, ability to work independently and efficiently, 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. Industry: Pharmaceutical Manufacturing.
#J-18808-Ljbffr