Onco360 Oncology Pharmacy
Pharmacy Claims Adjudication Specialist
Onco360 Oncology Pharmacy, Houston, Texas, United States, 77246
Join to apply for the
Pharmacy Claims Adjudication Specialist
role at
Onco360 Oncology Pharmacy .
This is a full‑time hybrid position located within driving distance of our Houston, TX pharmacy.
Starting salary: $20.00 an hour and up. Sign‑On Bonus: $5,000 for employees starting before February 1, 2026.
Benefits
Medical, Dental, Vision
401(k) with match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Company paid life & short and long‑term disability
Key Responsibilities
Adjudicate pharmacy claims and review claim responses for accuracy.
Ensure prescription claims are adjudicated correctly according to the coordination of benefits.
Resolve third‑party rejections, obtain overrides when appropriate.
Initiate patient outreach notifications regarding delays due to insurance claim rejections.
Provide first‑call resolution to health care providers and patients with pharmacy needs.
Ensure complete and accurate patient setup in CPR+ system, including demographic and insurance information.
Contact insurance companies to resolve third‑party rejections and ensure claims are cleared for timely medication shipment.
Perform outreach calls to patients or providers to reschedule medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays.
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 to ensure prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
Serve as customer service liaison to patients regarding financial responsibility prior to shipments, communicate any copay discrepancies, and collect payment if applicable.
Document and submit requests for patient refunds when appropriate.
Education and Learning Experience
Required: High School Diploma or GED; prior experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication.
Desired: Associate degree or equivalent program, 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 and 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 terminology; basic math and analytical skills; intermediate typing/keyboarding skills.
Desired: Knowledge of Foundation Funding; Specialty pharmacy experience.
Licenses and Certifications
Required: Registration with Board of Pharmacy as required by state law.
Desired: Certified Pharmacy Technician (PTCB).
Behavior Competencies
Independent worker with good interpersonal skills.
Excellent verbal and written communication skills.
Ability to work efficiently, meet deadlines, and be flexible.
Detail‑oriented with great time‑management skills.
Company Values #Company Values: Teamwork, Respect, Integrity, Passion
Location: Houston, TX
#J-18808-Ljbffr
Pharmacy Claims Adjudication Specialist
role at
Onco360 Oncology Pharmacy .
This is a full‑time hybrid position located within driving distance of our Houston, TX pharmacy.
Starting salary: $20.00 an hour and up. Sign‑On Bonus: $5,000 for employees starting before February 1, 2026.
Benefits
Medical, Dental, Vision
401(k) with match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Company paid life & short and long‑term disability
Key Responsibilities
Adjudicate pharmacy claims and review claim responses for accuracy.
Ensure prescription claims are adjudicated correctly according to the coordination of benefits.
Resolve third‑party rejections, obtain overrides when appropriate.
Initiate patient outreach notifications regarding delays due to insurance claim rejections.
Provide first‑call resolution to health care providers and patients with pharmacy needs.
Ensure complete and accurate patient setup in CPR+ system, including demographic and insurance information.
Contact insurance companies to resolve third‑party rejections and ensure claims are cleared for timely medication shipment.
Perform outreach calls to patients or providers to reschedule medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays.
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 to ensure prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
Serve as customer service liaison to patients regarding financial responsibility prior to shipments, communicate any copay discrepancies, and collect payment if applicable.
Document and submit requests for patient refunds when appropriate.
Education and Learning Experience
Required: High School Diploma or GED; prior experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication.
Desired: Associate degree or equivalent program, 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 and 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 terminology; basic math and analytical skills; intermediate typing/keyboarding skills.
Desired: Knowledge of Foundation Funding; Specialty pharmacy experience.
Licenses and Certifications
Required: Registration with Board of Pharmacy as required by state law.
Desired: Certified Pharmacy Technician (PTCB).
Behavior Competencies
Independent worker with good interpersonal skills.
Excellent verbal and written communication skills.
Ability to work efficiently, meet deadlines, and be flexible.
Detail‑oriented with great time‑management skills.
Company Values #Company Values: Teamwork, Respect, Integrity, Passion
Location: Houston, TX
#J-18808-Ljbffr