Pharmacy Claims Adjudication Specialist
4 hours ago
We are seeking a highly skilled Pharmacy Adjudication Specialist to join our team at Onco360 Pharmacy in New Hyde Park, NY. This is a full-time position with a hybrid work style, requiring a driving distance to our pharmacy.
Job Summary:The Pharmacy Adjudication Specialist will be responsible for adjudicating pharmacy claims, reviewing claim responses for accuracy, and ensuring prescription claims are adjudicated correctly according to the coordination of benefits. The ideal candidate will have excellent communication skills, attention to detail, and the ability to work independently.
Key Responsibilities:- Adjudicate pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans.
- Review claim responses for accuracy and ensure prescription claims are adjudicated correctly according to the coordination of benefits.
- Resolve third-party rejections and ensure pharmacy claim rejections are resolved to allow for timely shipping of medications.
- Perform outreach calls to patients or providers to reschedule medication deliveries if claim resolution cannot be completed by ship date.
- Ensure copay cards are only applied to claims for eligible patients based on set criteria.
- Manage all funding related adjudications and work as a liaison to the Onco360 Advocate team.
- Assist the pharmacy team with the management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
- Document and submit requests for Patient Refunds when appropriate.
- High School Diploma or GED.
- Previous experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication.
- 1+ years of experience in a Pharmacy/Healthcare Setting or pharmacy claims experience.
- Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance.
- Registration with the Board of Pharmacy as required by state law.
- Associate degree or equivalent program from a 2-year program or technical school.
- Certified Pharmacy Technician.
- Specialty pharmacy experience.
- Knowledge of Foundation Funding.
- 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.
We offer a competitive salary from $23.00 an hour and up, as well as a variety of benefits including medical, dental, vision, 401k with a match, paid time off, paid holidays, tuition reimbursement, and company-paid benefits such as life, short-term, and long-term disability insurance.
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