Onco360 is one of the largest independent providers of Oncology Pharmacy services in the country.  The company was founded in 2003 to bring together the stakeholders involved in the cancer treatment process and serve the specialized needs of oncologists, patients, hospitals, cancer centers of excellence, manufacturers, health plans, and payers.   

The company’s clinical and dispensing model was developed specifically to meet the unique needs of oncology-treating physicians and their patients. 

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- and JCAHO-accredited Oncology Pharmacies.

Industry: Pharmaceutical Manufacturing
Company Size: 501-1,000 employees

Onco360 Oncology Pharmacy

Savvy Admin PROD

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in **Waltham, MA. ** This will be a Full-Time position. **This position must be located within driving distance to our pharmacy, with a hybrid work style.**

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 $26.00 an hour and up**

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.

- Document and submit requests for Patient Refunds when appropriate.

**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: 1+ 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

Pharmacy Adjudication Specialist

Mass General Brigham is an integrated academic health care system, uniting great minds to solve the hardest problems in medicine for our communities and the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a nonprofit organization that is committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School.

Industry: Hospitals and Health Care
Company Size: 10,001+ employees

Mass General Brigham

Site: Newton-Wellesley Hospital

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

The Mass General Brigham Medical Group is a system-led operating entity established by Mass General Brigham to provide patient-centered, high-quality, and innovative community-based ambulatory care. This initiative is part of Mass General Brigham’s unified system strategy, which aims to bring health care services closer to patients while simultaneously reducing overall health care costs. The Medical Group offers a comprehensive array of services, including primary and specialty care, behavioral and mental health services, and urgent care. Care is delivered both digitally and at physical locations across Massachusetts, New Hampshire, and Maine. In addition, the group provides outpatient surgery and endoscopy, imaging, cardiac testing, and infusion services. There is a strong commitment to ensuring patients receive coordinated and comprehensive experience at all locations, guaranteeing that each patient has access to the appropriate level of care throughout the system’s delivery sites.

The Division of Rheumatology at Newton-Wellesley Hospital provides patient care, medical education, and clinical research. Members of the division perform all outpatient, emergency room, and inpatient evaluations for patients with rheumatic disorders. State-of-the-art treatment is provided for conditions and diseases affecting the musculoskeletal system, which includes joints, soft tissues, connective tissues, muscles, and bones. Our physicians diagnose and treat autoimmune diseases and different types of arthritis.

We are seeking a Part-Time, 12-hour, Physician Assistant to support our Rheumatology team in a twenty-week pilot role, with the potential to transition into a permanent, budgeted position in 2027. This is a primarily remote position, with the possibility of future on-site responsibilities as program needs evolve. The Physician Assistant will provide patient counseling and manage a range of in-basket responsibilities.

**Job Summary**

The Physician Assistant (PA) is a licensed provider. The PA is responsible for the assessment and management of various populations of patients, medical and/or surgical, including diagnostic and therapeutic interventions, development of appropriate plans of care and ongoing evaluation. May also perform additional duties, such as precepting a small group of learners.

Does this position require Patient Care?

Yes

**Essential Functions**

- Provides direct care, counseling, and teaching to a designated patient population in the ambulatory, inpatient, operative, and/or procedural setting.

- Performs complete histories and physical examinations.

- Orders, interprets, and evaluates appropriate laboratory and diagnostic tests.

- Develops appropriate plans of care and follow-up based on the outcomes of diagnostic, laboratory, and physical examination findings.

- Orders medications and writes prescriptions according to organizational and regulatory policies and procedures.

- Consistently provides high quality and timely documentation including admission and progress notes, procedure notes, operative notes and discharge summaries.

- Performs bedside procedures as are appropriate to the patient population.

**Qualifications**

Education

Master's Degree Physician Assistant required

Can this role accept experience in lieu of a degree?

No

Licenses and Credentials

Physician Assistant [State License] - Generic - HR Only required

**Experience**

2 years of experience as a PA required

**Additional Job Details (if Applicable)**

Previous experience as a Physician Assistant in Rheumatology is required.

**Remote Type**

Hybrid

**Work Location**

2000 Washington Street

**Scheduled Weekly Hours**

12

**Employee Type**

Regular

**Work Shift**

Day (United States of America)

**Pay Range**

$122,803.20 - $173,867.20/Annual

**Grade**

7

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

**EEO Statement**

4100 Newton-Wellesley Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

**Mass General Brigham Competency Framework**

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Physician Assistant, Rheumatology

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