Pharmacy Claims Adjudication Specialist

Onco360•Indianapolis, IN

17d•$25•Remote

About The Position

Onco360 is seeking a Pharmacy Adjudication Specialist for its Specialty Oncology pharmacy. This full-time role may be performed remotely, but requires active Indiana Pharmacy Technician credentials from the State Board of Pharmacy. Shift times fall between 8 a.m. and 8 p.m. Starting pay is $25.00 per hour and up. A $5,000 sign-on bonus is offered to employees starting before December 31, 2026. The specialist adjudicates pharmacy claims and reviews claim responses for accuracy. The role includes resolving third-party rejections, obtaining appropriate overrides, coordinating benefits across plans, and notifying patients when insurance claim issues delay medication delivery. The specialist also supports patients, providers, and pharmacy operations with claim inquiries, copay and funding matters, patient setup, and delivery assessments.

Requirements

High school diploma or GED.
At least 2 years of experience in a pharmacy or health care setting, or pharmacy claims experience.
Pharmacy Technician License/Registration with the Board of Pharmacy as required by state law; the position description specifically requires active Indiana Pharmacy Technician credentials from the State Board of Pharmacy.
Knowledge of pharmacy/NDC medication billing, pharmacy claims resolution, PBM and medical contracts, Medicare, Medicaid, commercial insurance, NCPDP claim rejection resolution, and coordination of benefits.
Pharmacy or health care-related knowledge, including pharmacy terminology such as sig codes and Roman numerals, and brand and generic medication names.
Basic math and analytical skills and intermediate typing/keyboarding skills.
Ability to work independently, with good interpersonal skills and excellent verbal and written communication skills.
Ability to work efficiently to meet deadlines and remain flexible.
Detail orientation and strong time-management skills.

Nice To Haves

Associate degree or equivalent program from a two-year program or technical school.
Certified Pharmacy Technician.
Specialty pharmacy experience.
At least 3 years of experience in a pharmacy or health care setting, or pharmacy claims experience.
Knowledge of Foundation Funding.

Responsibilities

Practice first-call resolution by assisting health care providers and patients with pharmacy needs, questions, and requests.
Provide thorough, accurate, and timely responses to pharmacy operations, providers, and patients regarding active claims.
Ensure complete and accurate patient setup in the CPR+ system, including demographic and insurance information.
Adjudicate active-workflow prescription claims across primary, secondary, and tertiary pharmacy plans, and review responses for accuracy before accepting claims.
Contact insurance companies to resolve third-party rejections and obtain appropriate overrides so medications can be shipped on time.
Contact patients or providers to reschedule medication deliveries when unresolved claim issues cause shipment delays.
Ensure copay cards are applied only to eligible patients according to established criteria, including restrictions for government beneficiaries.
Manage funding-related adjudications and serve as a liaison to the Onco360 Advocate team.
Assist the pharmacy team in managing electronically adjudicated claims, reconciling prescription delivery assessments, and ensuring copay payments are charged before shipment.
Communicate financial responsibility to patients before shipment, address discrepancies between quoted and claimed copays, and collect payment when applicable.
Document and submit patient refund requests when appropriate.
Maintain a safe and clean pharmacy by following procedures, rules, regulations, and professional practice and patient confidentiality laws.
Contribute to team efforts by completing related tasks and other assigned duties.
Perform responsibilities in accordance with the company's Code of Business Conduct and Ethics, policies and procedures, Corporate Compliance Agreement, applicable laws, and professional standards.