This job is closed
Applications are no longer available for this announcement. Explore current related opportunities below.
Job description
Position Overview
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in New Hyde Park, NY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style.
Shift Times
Shift times are between 8am and 8pm.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
Salary and Bonus
Starting salary from $26.00 an hour and up.
Sign-On Bonus: $5,000 for employees starting before October 31st, 2026.
Benefits
Medical; Dental; Vision
401k with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Company paid benefits - life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities
Pharmacy Adjudication Specialists at Onco360...
Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.
Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
Adjudicates 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.
Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
Documents and submit requests for Patient Refunds when appropriate.
Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Qualifications & Responsibilities
Education/Learning Experience Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
Work Experience Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Skills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
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 Required: 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
Company Values
Teamwork, Respect, Integrity, Passion
#J-18808-Ljbffr
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.