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$24/hr
Full-time
high school, associate degree, professional certificate
Medical, Dental, Vision, 401k With A Match, Paid Time Off, Paid Holidays
Posted 1d ago
~40 hrs/week
Responsibilities
The specialist is responsible for adjudicating pharmacy claims, resolving third-party rejections, and ensuring accurate coordination of benefits. They also handle patient outreach regarding medication delays and manage financial responsibilities and copayments prior to shipment.
Requirements
Requires a high school diploma or GED and at least 2 years of experience in a pharmacy or healthcare setting. Candidates must be registered with the Board of Pharmacy as required by state law and possess strong knowledge of medication billing and insurance contracts.
Full job description
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Woodridge, IL. 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 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.
Starting salary from $24.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before July 31, 2026.
We offer a variety of benefits including:
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:
The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections
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.
Pharmacy Adjudication Specialist Qualifications and 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
Onco360 is recognized as one of the nation's leading independent specialty pharmacies dedicated exclusively to oncology and rare disease patients. Through its comprehensive patient support programs, clinical expertise, and commitment to personalized care, we play a critical role in helping patients access, manage, and adhere to complex therapies while navigating the challenges associated with cancer treatment.
We focus on delivering specialized pharmacy services and improving the patient experience positions us at the forefront of healthcare innovation. By collaborating with healthcare providers, pharmaceutical manufacturers, and patient communities, Onco360 is helping bridge the gap between therapeutic innovation and real-world patient outcomes.
In its focus to bring together the stakeholders involved in the cancer treatment process, Onco360 is advancing the continuum of oncology pharmaceutical care through patient advocacy, dispensing excellence, and the clinical experience and expertise that comes from its focus in oncology.
Onco360 is headquartered in Louisville, KY and dispenses nationally through its network URAC, ACHC, NAPB, and JCAHO accredited Oncology Pharmacies.
Offices: 13410 Eastpoint Centre Dr, Louisville, Kentucky 40223, US · 335 Bear Hill Road, Waltham, MA 02451, US · 140 John James Audubon Pkwy, Suite 101, Amherst, New York 14228, US · 1985 Marcus Ave suite 120, New Hyde Park, NY 11021, US · 4700 W Sam Houston Pkwy N, Suite 150, Houston, Texas 77041, US
Oncology PharmacyInsurance and Benefit InvestigationsSpecialty PharmacyOncology-Specific PharmacyIndependent Oncology PharmacyBoard Certified Oncology PharmacistsLimited Distribution MedicationsCancer CareOncology Specialty PharmacyMedication Therapy Management Programs
Onco360 is recognized as one of the nation's leading independent specialty pharmacies dedicated exclusively to oncology and rare disease patients. Through its comprehensive patient support programs, clinical expertise, and commitment to personalized care, we play a critical role in helping patients access, manage, and adhere to complex therapies while navigating the challenges associated with cancer treatment.
We focus on delivering specialized pharmacy services and improving the patient experience positions us at the forefront of healthcare innovation. By collaborating with healthcare providers, pharmaceutical manufacturers, and patient communities, Onco360 is helping bridge the gap between therapeutic innovation and real-world patient outcomes.
In its focus to bring together the stakeholders involved in the cancer treatment process, Onco360 is advancing the continuum of oncology pharmaceutical care through patient advocacy, dispensing excellence, and the clinical experience and expertise that comes from its focus in oncology.
Onco360 is headquartered in Louisville, KY and dispenses nationally through its network URAC, ACHC, NAPB, and JCAHO accredited Oncology Pharmacies.
Offices: 13410 Eastpoint Centre Dr, Louisville, Kentucky 40223, US · 335 Bear Hill Road, Waltham, MA 02451, US · 140 John James Audubon Pkwy, Suite 101, Amherst, New York 14228, US · 1985 Marcus Ave suite 120, New Hyde Park, NY 11021, US · 4700 W Sam Houston Pkwy N, Suite 150, Houston, Texas 77041, US
Oncology PharmacyInsurance and Benefit InvestigationsSpecialty PharmacyOncology-Specific PharmacyIndependent Oncology PharmacyBoard Certified Oncology PharmacistsLimited Distribution MedicationsCancer CareOncology Specialty PharmacyMedication Therapy Management Programs