Pharmacy Claims Adjudication Specialist

Onco360•Hartford, CT

5d•$26

About The Position

Onco360 Pharmacy is seeking a Pharmacy Adjudication Specialist for its Specialty Oncology pharmacy. This full-time position may be performed remotely, but requires active Connecticut Pharmacy Technician credentials from the State Board of Pharmacy. Shift times fall between 8 a.m. and 8 p.m. The position adjudicates pharmacy claims, checks claim responses for accuracy, resolves third-party rejections, obtains appropriate overrides, and communicates with patients about delivery delays caused by insurance claim issues. The starting salary is $26.00 per hour and up. A $5,000 sign-on bonus is offered to employees starting before December 31, 2026. Onco360 Pharmacy is an oncology pharmacy model serving community, oncology, and hematology physicians, patients, payers, and manufacturers. The specialist supports pharmacy operations by providing accurate and timely claims assistance, coordinating insurance and funding-related adjudications, and helping ensure claims and copay payments are reconciled before medication shipments. The role also includes patient and provider outreach, payment collection when applicable, documentation of refund requests, and compliance with pharmacy procedures, confidentiality requirements, applicable laws, and professional standards.

Requirements

Active Connecticut Pharmacy Technician credentials from the State Board of Pharmacy.
High school diploma or GED.
Previous experience in pharmacy, medical billing, benefits verification, or pharmacy claims adjudication.
At least 2 years of experience in a pharmacy or healthcare setting, or pharmacy claims experience.
Knowledge of pharmacy/NDC medication billing and pharmacy claims resolution.
Knowledge of PBM and medical contracts and 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 medication brand and generic 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 (PTCB).
Specialty pharmacy experience.
Knowledge of Foundation Funding.
Registration with a Board of Pharmacy as required by state law.

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 patient records are set up accurately and completely 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 be shipped 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 restrictions on government beneficiaries.
Manage funding-related adjudications and liaise with the Onco360 Advocate team.
Assist the pharmacy team with electronically adjudicated claims and ensure prescription delivery assessments are reconciled and copay payments are charged before shipment.
Communicate patients’ financial responsibility before shipment, explain discrepancies between quoted copays and claims, 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.
Complete related tasks and other duties as assigned.
Perform responsibilities in accordance with the Company’s Code of Business Conduct and Ethics, company policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.