Pharmacy Claims Adjudication Specialist

4 weeks ago


Woodridge, Illinois, United States Onco360 Full time

About the Role:

We are seeking a highly skilled Pharmacy Adjudication Specialist to join our team at Onco360 Pharmacy. As a Pharmacy Adjudication Specialist, you 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.

Key Responsibilities:

  • Adjudicate pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
  • Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications.
  • Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays.
  • Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible).
  • Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.

Requirements:

  • High School Diploma or GED.
  • Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication.
  • Registration with Board of Pharmacy as required by state law.

Preferred Qualifications:

  • Associate degree or equivalent program from a 2 year program or technical school.
  • Certified Pharmacy Technician.
  • Specialty pharmacy experience.

What We Offer:

  • Starting salary from $20.00 an hour and up.
  • Medical; Dental; Vision benefits.
  • 401k with a match.
  • Paid Time Off and Paid Holidays.
  • Tuition Reimbursement.
  • Company paid benefits - life; and short and long-term disability.

How to Apply:

Please submit your application to join our team at Onco360 Pharmacy. We look forward to hearing from you.



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