Pharmacy Claims Adjudication Specialist

Onco360•Scottsdale, AZ

17d•$23•Hybrid

About The Position

Onco360 Pharmacy is hiring a full-time Pharmacy Claims Adjudication Specialist for its specialty pharmacy in Scottsdale, Arizona. The position is a remote hybrid opportunity after an onsite training period, with shift hours scheduled between 8 a.m. and 8 p.m. The starting salary is $23.00 per hour and up. A $5,000 sign-on bonus is offered to employees who start before December 31, 2026. The specialist adjudicates pharmacy claims and reviews responses for accuracy, resolves third-party rejections, obtains appropriate overrides, and contacts patients or providers when insurance claim issues delay medication delivery. The role also supports accurate patient and insurance setup, copay and funding adjudications, payment collection, and coordination with pharmacy operations and the Onco360 Advocate team. Work must comply with company policies, professional standards, applicable laws, and patient confidentiality requirements.

Requirements

High school diploma or GED.
At least 2 years of experience in a pharmacy or healthcare setting, or pharmacy claims experience.
Previous experience in pharmacy, medical billing, benefits verification, or pharmacy claims adjudication.
Knowledge of pharmacy/NDC medication billing and pharmacy claims resolution.
Knowledge of PBM and medical contracts and understanding of Medicare, Medicaid, and commercial insurance.
Knowledge of NCPDP claim rejection resolution and coordination of benefits.
Pharmacy or healthcare-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.
Registration with the Board of Pharmacy as required by state law.
Ability to work independently, with good interpersonal skills and excellent verbal and written communication skills.
Ability to work efficiently to meet deadlines and be flexible, with attention to detail and strong time-management skills.

Nice To Haves

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

Responsibilities

Practice first-call resolution by answering healthcare providers’ and patients’ pharmacy-related questions and requests.
Provide thorough, accurate, and timely responses to pharmacy operations, providers, and patients regarding active claim information.
Ensure complete and accurate patient setup in the CPR+ system, including demographic and insurance information.
Adjudicate active-workflow prescription claims for primary, secondary, and tertiary pharmacy plans, and review claim responses for accuracy before accepting claims.
Contact insurance companies to resolve third-party rejections and obtain appropriate overrides so medications can ship on time.
Contact patients or providers to reschedule medication deliveries when unresolved claim issues cause shipment delays.
Apply copay cards only to eligible patients according to established criteria, including insurance type restrictions for government beneficiaries.
Manage funding-related adjudications and serve as a liaison to the Onco360 Advocate team.
Assist with electronically adjudicated claims, ensuring prescription delivery assessments are reconciled and copay payments are charged before shipment.
Communicate patients’ financial responsibility before shipment, address discrepancies between quoted copays and claim amounts, 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 duties as assigned.
Conduct work in accordance with the Company’s Code of Business Conduct and Ethics, policies and procedures, Corporate Compliance Agreement, applicable federal and state laws, and professional standards.