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

**Are you someone looking for professional career growth? **Onco360 Pharmacy is looking for **Pharmacy Benefit Verification Specialists ** for our Pharmacy located in **Louisville, KY.**

**Work Hours: Monday-Friday shifts available; ****some weekends as needed.**

- Starting salary at $22/hr and up** We also offer quarterly incentive bonuses.

Onco360 is a Closed door specialty pharmacy that focuses on patients who are currently undergoing cancer treatment. Our patients are important to us, so we always strive to meet and exceed their needs. We are seeking **Pharmacy Benefit Verification Specialist ** s who go above and beyond for our patients, and also passionate about helping others.

We offer a variety of benefits including:

- Medical, Dental & Vision insurance

- 401k with a match

- Paid Time Off and Paid Holidays

- Tuition Reimbursement

- Paid Volunteer Day

- Floating Holiday

- Referral Incentive

- Paid Life, and short & long-term disability insurance

**Pharmacy ****Benefit Verification ****Specialist Summary:**

The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs. They will ensure accurate benefit documentation is made for all prescription orders.

**Pharmacy ****Benefit Verification ****Specialist Major Responsibilities:**

- 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 benefit information.

- Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.

- Performs full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profile.

- Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement, then document outcome of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy.

- Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.

- 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 ****Benefit Verification ****Specialist Qualifications: **

- Education/Learning Experience

- Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification

- Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience

- Work Experience

- Required: 1+ years pharmacy or benefit verification experience

- Desired: 3+ years pharmacy or benefit verification experience

- Skills/Knowledge:

- Required: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, 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.

- 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

**#Company Values: Teamwork, Respect, Integrity, Passion **

Pharmacy Benefits Verification Specialist

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in **Louisville, KY. ** 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 currently available: 8:30am-5:00 pm EST, 10:30 am-7:00 pm EST, or 11:30am-8:00 pm EST**

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 $21.00 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

**#Company Values: Teamwork, Respect, Integrity, Passion**

#IH

Pharmacy Claims Adjudication Specialist

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in **Louisville, KY. ** 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 currently available: 8:30am-5:00 pm EST, 10:30 am-7:00 pm EST, or 11:30am-8:00 pm EST**

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 $21.00 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 ExperienceRequired: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims AdjudicationDesired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience

- Work ExperienceRequired: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experienceDesired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience

- Skills/KnowledgeRequired: 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 skillsDesired: Knowledge of Foundation Funding, Specialty pharmacy experience

- Licenses/Certifications Required: Registration with Board of Pharmacy as required by state lawDesired: Certified Pharmacy Technician (PTCB)

- Behavior CompetenciesRequired: 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

**#Company Values: Teamwork, Respect, Integrity, Passion**

#IH

Great opportunity for career growth! We are seeking **Fulfillment/Phone Support ****Pharmacy Technicians ** at our Specialty Pharmacy located in **Buffalo, NY. ** These are full-time positions and the shifts available are **Monday through ** **Friday, 8:30 am to 5 pm EST.**

- Starting salary at $24.00/hr and up**

**We offer a variety of benefits including ** :

- Quarterly Incentive Bonuses

- Medical, Dental & Vision insurance

- 401k with a match

- Paid Time Off and Paid Holidays

- Tuition Reimbursement

- Paid Volunteer Day

- Floating Holiday

- Referral Incentive

- Paid Life, and short & long-term disability insurance

**Who We Are**

Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.

A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion. We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.

**Fulfillment/Phone Support Pharmacy Technician Summary:**

The pharmacy technician will assist pharmacists, technician leads, supervisors, and managers in daily workflow to dispense specialty prescription medications to patients or providers and other pharmacy related functions. They will ensure all assigned tasks are completed daily.

**Fulfillment Pharmacy Technician ****Major Responsibilities:**

- Prepare prescriptions to be dispensed including printing labels; selecting and pulling medications from stock shelves, counting medications, and labeling the final product for dispense

- Packaging and organizing daily Rx orders for shipment

- Receive, order, and manage medication inventory

- Ability to work independently, meet deadlines and be flexible

- Good organizational skills and detail oriented

- Knowledge of medical terminology (including sig codes and Roman numeral), brand and generic names of medications and general pharmacy terminology

- Ability to perform tasks accurately and efficiently when inputting information

- Basic math and analytical skills

**Fulfillment/Phone Support Pharmacy Technician Qualifications:**

**Education/Learning Experience**

- Required: High School Diploma or GED

**Work Experience**

- Required: 1+ years’ pharmacy experience

**Skills/Knowledge**

- Required: 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.

**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

**Company Values: Teamwork, Respect, Integrity, Passion **

Pharmacy Technician - Fulfillment/Phone Support

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in **New Hyde Park, NY. ** 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

**#Company Values: Teamwork, Respect, Integrity, Passion **

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in **Buffalo, NY. ** 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 $23.00 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

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in**Scottsdale, AZ. ** This will be a Full-Time position. This is a **remote hybrid opportunity, after onsite training period.**

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 $23.00 an hour and up**

Shifts: 8am-4:30 pm MST and 8:30 am-5pm MST

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

**#Company Values: Teamwork, Respect, Integrity, Passion**

#IH

W e 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.**

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**

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

**#Company Values: Teamwork, Respect, Integrity, Passion **

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

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in**Houston, TX. ** 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 $21.00 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

#IH

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in **Louisville, KY. ** 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 $21.00 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

**#Company Values: Teamwork, Respect, Integrity, Passion**

#IH

**Pharmacy Prior Authorization Specialist – Onco360 Pharmacy**

~~Scottsdale, AZ ~~| ~~Full-Time ~~ | ~~Starting at $23.00/hr and up~~

**Join a mission-driven team making a difference in the lives of cancer patients.**

Onco360 Pharmacy is seeking a **Pharmacy Prior Authorization Specialist ** to join our dedicated team in Scottsdale, AZ. This is a full-time position ideal for candidates local to the area. **Remote work possible after initial on-site training.**

**Why Join Us?**

- A career with purpose: Help patients access life-saving medications.

- Supportive culture: We value teamwork, respect, integrity, and passion.

- Growth opportunities: We invest in your professional and personal development.

**Company Benefits**

- Medical; Dental; Vision

- 401k with a match

- Paid Time Off and Paid Holidays

- Tuition Reimbursement

- Quarterly Incentive Bonus

- Paid Volunteer Day

- Referral Incentive Program

- Company Paid Life Insurance; and Short/Long-Term Disability

**What You’ll Do**

The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.

**How You’ll Do This**

- Manage prior authorization requests and appeals with insurance carriers.

- Collaborate with physicians, pharmacists, and other departments.

- Ensure HIPAA compliance while handling sensitive patient information.

- Maintain accurate documentation of authorization details.

- Proactively monitor and renew expiring authorizations.

**What You Bring**

~~**Required:** ~~

- High School Diploma or GED

- 1+ years of pharmacy or prior authorization experience

- Registration with Board of Pharmacy (as required by state law)

- Strong communication, organizational, and customer service skills

- Self-motivated, organized, detail-oriented, and adaptable to changing priorities

- Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds

**Preferred:**

- Associate degree or Certified Pharmacy Technician (PTCB)

- 3+ years of experience in pharmacy or prior authorizations

- Specialty pharmacy experience

**Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.**

**#Company Values: Teamwork, Respect, Integrity, Passion **

Pharmacy Prior Authorization Specialist

**Pharmacy Prior Authorization Specialist – Onco360 Pharmacy**

~~Houston, TX ~~| ~~Full-Time ~~ | ~~Starting at $23.00/hr and up~~

**Join a mission-driven team making a difference in the lives of cancer patients.**

Onco360 Pharmacy is seeking a **Pharmacy Prior Authorization Specialist ** to join our dedicated team in Houston, TX. This is a full-time position ideal for candidates local to the area. **Remote work possible after initial on-site training.**

**Why Join Us?**

- A career with purpose: Help patients access life-saving medications.

- Supportive culture: We value teamwork, respect, integrity, and passion.

- Growth opportunities: We invest in your professional and personal development.

**Company Benefits**

- Medical; Dental; Vision

- 401k with a match

- Paid Time Off and Paid Holidays

- Tuition Reimbursement

- Quarterly Incentive Bonus

- Paid Volunteer Day

- Referral Incentive Program

- Company Paid Life Insurance; and Short/Long-Term Disability

**What You’ll Do**

The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.

**How You’ll Do This**

- Manage prior authorization requests and appeals with insurance carriers.

- Collaborate with physicians, pharmacists, and other departments.

- Ensure HIPAA compliance while handling sensitive patient information.

- Maintain accurate documentation of authorization details.

- Proactively monitor and renew expiring authorizations.

**What You Bring**

~~**Required:** ~~

- High School Diploma or GED

- 1+ years of pharmacy or prior authorization experience

- Registration with Board of Pharmacy (as required by state law)

- Strong communication, organizational, and customer service skills

- Self-motivated, organized, detail-oriented, and adaptable to changing priorities

- Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds

**Preferred:**

- Associate degree or Certified Pharmacy Technician (PTCB)

- 3+ years of experience in pharmacy or prior authorizations

- Specialty pharmacy experience

**Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.**

#IH

**Pharmacy Prior Authorization Specialist – Onco360 Pharmacy**

~~New Hyde Park, NY ~~ | ~~Full-Time ~~ | ~~Starting at $25.00/hr and up~~

**Join a mission-driven team making a difference in the lives of cancer and rare disease patients.**

Onco360 Pharmacy is seeking a **Pharmacy Prior Authorization Specialist ** to join our dedicated team in New Hyde Park, NY. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.

**Why Join Us?**

- A career with purpose: Help patients access life-saving medications.

- Supportive culture: We value teamwork, respect, integrity, and passion.

- Growth opportunities: We invest in your professional and personal development.

**Company Benefits**

- Medical; Dental; Vision

- 401k with a match

- Paid Time Off and Paid Holidays

- Tuition Reimbursement

- Quarterly Incentive Bonus

- Paid Volunteer Day

- Referral Incentive Program

- Company Paid Life Insurance; and Short/Long-Term Disability

**What You’ll Do**

The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.

**How You’ll Do This**

- Manage prior authorization requests and appeals with insurance carriers.

- Collaborate with physicians, pharmacists, and other departments.

- Ensure HIPAA compliance while handling sensitive patient information.

- Maintain accurate documentation of authorization details.

- Proactively monitor and renew expiring authorizations.

**What You Bring**

**Required:**

- High School Diploma or GED

- 1+ years of pharmacy or prior authorization experience

- Registration with Board of Pharmacy (as required by state law)

- Strong communication, organizational, and customer service skills

- Self-motivated, organized, detail-oriented, and adaptable to changing priorities

- Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds

**Preferred:**

- Associate degree or Certified Pharmacy Technician (PTCB)

- 3+ years of experience in pharmacy or prior authorizations

- Specialty pharmacy experience

**Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.**

**#Company Values: Teamwork, Respect, Integrity, Passion **

**Pharmacy Prior Authorization Specialist – Onco360 Pharmacy**

~~Buffalo, NY ~~ | ~~Full-Time ~~ | ~~Starting at $23.00/hr and up~~

**Join a mission-driven team making a difference in the lives of cancer patients.**

Onco360 Pharmacy is seeking a **Pharmacy Prior Authorization Specialist ** to join our dedicated team in Buffalo, NY. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.

**Company Benefits**

- Medical; Dental; Vision

- 401k with a match

- Paid Time Off and Paid Holidays

- Tuition Reimbursement

- Quarterly Incentive Bonus

- Paid Volunteer Day

- Referral Incentive Program

- Company Paid Life Insurance; and Short/Long-Term Disability

**Why Join Us?**

- A career with purpose: Help patients access life-saving medications.

- Supportive culture: We value teamwork, respect, integrity, and passion.

- Growth opportunities: We invest in your professional and personal development.

**What You’ll Do**

The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.

**How You’ll Do This**

- Manage prior authorization requests and appeals with insurance carriers.

- Collaborate with physicians, pharmacists, and other departments.

- Ensure HIPAA compliance while handling sensitive patient information.

- Maintain accurate documentation of authorization details.

- Proactively monitor and renew expiring authorizations.

**What You Bring**

~~**Required:** ~~

- High School Diploma or GED

- 1+ years of pharmacy or prior authorization experience

- Registration with Board of Pharmacy (as required by state law)

- Strong communication, organizational, and customer service skills

- Self-motivated, organized, detail-oriented, and adaptable to changing priorities

- Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds

~~**Preferred:** ~~

- Associate degree or Certified Pharmacy Technician (PTCB)

- 3+ years of experience in pharmacy or prior authorizations

- Specialty pharmacy experience

**Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.**

**#Company Values: Teamwork, Respect, Integrity, Passion **

**Pharmacy Prior Authorization Specialist – Onco360 Pharmacy**

~~Louisville, KY ~~ | ~~Full-Time ~~ | ~~Starting at $23.00/hr and up~~

Onco360 Pharmacy is seeking a **Pharmacy Prior Authorization Specialist ** to join our dedicated team in Louisville, KY. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.

**Why Join Us?**

- A career with purpose: Help patients access life-saving medications.

- Supportive culture: We value teamwork, respect, integrity, and passion.

- Growth opportunities: We invest in your professional and personal development.

**Company Benefits**

- Medical; Dental; Vision

- 401k with a match

- Paid Time Off and Paid Holidays

- Tuition Reimbursement

- Quarterly Incentive Bonus

- Paid Volunteer Day

- Referral Incentive Program

- Company Paid Life Insurance; and Short/Long-Term Disability

**What You’ll Do**

The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.

**How You’ll Do This**

- Manage prior authorization requests and appeals with insurance carriers.

- Collaborate with physicians, pharmacists, and other departments.

- Ensure HIPAA compliance while handling sensitive patient information.

- Maintain accurate documentation of authorization details.

- Proactively monitor and renew expiring authorizations.

**What You Bring**

~~**Required:** ~~

- High School Diploma or GED

- 1+ years of pharmacy or prior authorization experience

- Registration with Board of Pharmacy (as required by state law)

- Strong communication, organizational, and customer service skills

- Self-motivated, organized, detail-oriented, and adaptable to changing priorities

- Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds

**Preferred:**

- Associate degree or Certified Pharmacy Technician (PTCB)

- 3+ years of experience in pharmacy or prior authorizations

- Specialty pharmacy experience

**Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.**

#IH

**Pharmacy Prior Authorization Specialist – Onco360 Pharmacy**

~~Woodridge, IL ~~ | ~~Full-Time ~~ | ~~Starting at $23.00/hr and up~~

**Join a mission-driven team making a difference in the lives of cancer patients.**

Onco360 Pharmacy is seeking a **Pharmacy Prior Authorization Specialist ** to join our dedicated team in Woodridge, IL. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.

**Why Join Us?**

- A career with purpose: Help patients access life-saving medications.

- Supportive culture: We value teamwork, respect, integrity, and passion.

- Growth opportunities: We invest in your professional and personal development.

**Company Benefits**

- Medical; Dental; Vision

- 401k with a match

- Paid Time Off and Paid Holidays

- Tuition Reimbursement

- Quarterly Incentive Bonus

- Paid Volunteer Day

- Referral Incentive Program

- Company Paid Life Insurance; and Short/Long-Term Disability

**What You’ll Do**

The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.

**How You’ll Do This**

- Manage prior authorization requests and appeals with insurance carriers.

- Collaborate with physicians, pharmacists, and other departments.

- Ensure HIPAA compliance while handling sensitive patient information.

- Maintain accurate documentation of authorization details.

- Proactively monitor and renew expiring authorizations.

**What You Bring**

~~**Required:** ~~

- High School Diploma or GED

- 1+ years of pharmacy or prior authorization experience

- Registration with Board of Pharmacy (as required by state law)

- Strong communication, organizational, and customer service skills

- Self-motivated, organized, detail-oriented, and adaptable to changing priorities

- Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds

**Preferred:**

- Associate degree or Certified Pharmacy Technician (PTCB)

- 3+ years of experience in pharmacy or prior authorizations

- Specialty pharmacy experience

**Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.**

**#Company Values: Teamwork, Respect, Integrity, Passion**

#IH

**Pharmacy Prior Authorization Specialist – Onco360 Pharmacy**

~~Waltham, MA ~~ | ~~Full-Time ~~ | ~~Starting at $23.00/hr and up~~

**Join a mission-driven team making a difference in the lives of cancer and rare disease patients.**

Onco360 Pharmacy is seeking a **Pharmacy Prior Authorization Specialist ** to join our dedicated team in Waltham, MA. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.

**Why Join Us?**

- A career with purpose: Help patients access life-saving medications.

- Supportive culture: We value teamwork, respect, integrity, and passion.

- Growth opportunities: We invest in your professional and personal development.

**Company Benefits**

- Medical; Dental; Vision

- 401k with a match

- Paid Time Off and Paid Holidays

- Tuition Reimbursement

- Quarterly Incentive Bonus

- Paid Volunteer Day

- Referral Incentive Program

- Company Paid Life Insurance; and Short/Long-Term Disability

**What You’ll Do**

The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.

**How You’ll Do This**

- Manage prior authorization requests and appeals with insurance carriers.

- Collaborate with physicians, pharmacists, and other departments.

- Ensure HIPAA compliance while handling sensitive patient information.

- Maintain accurate documentation of authorization details.

- Proactively monitor and renew expiring authorizations.

**What You Bring**

**Required:**

- High School Diploma or GED

- 1+ years of pharmacy or prior authorization experience

- Registration with Board of Pharmacy (as required by state law)

- Strong communication, organizational, and customer service skills

- Self-motivated, organized, detail-oriented, and adaptable to changing priorities

- Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds

**Preferred:**

- Associate degree or Certified Pharmacy Technician (PTCB)

- 3+ years of experience in pharmacy or prior authorizations

- Specialty pharmacy experience

**Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer. **

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in**Scottsdale, AZ. ** This will be a Full-Time position. This is a **remote hybrid opportunity, after onsite training period.**

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 $23.00 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

**#Company Values: Teamwork, Respect, Integrity, Passion**

#IH

Pharmacy Adjudication Specialist

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in **Louisville, KY. ** 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 $21.00 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 ExperienceRequired: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims AdjudicationDesired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience

- Work ExperienceRequired: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experienceDesired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience

- Skills/KnowledgeRequired: 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 skillsDesired: Knowledge of Foundation Funding, Specialty pharmacy experience

- Licenses/Certifications Required: Registration with Board of Pharmacy as required by state lawDesired: Certified Pharmacy Technician (PTCB)

- Behavior CompetenciesRequired: 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

**#Company Values: Teamwork, Respect, Integrity, Passion**

#IH

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in**Houston, TX. ** 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 $21.00 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 ExperienceRequired: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims AdjudicationDesired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience

- Work ExperienceRequired: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experienceDesired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience

- Skills/KnowledgeRequired: 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 skillsDesired: Knowledge of Foundation Funding, Specialty pharmacy experience

- Licenses/Certifications Required: Registration with Board of Pharmacy as required by state lawDesired: Certified Pharmacy Technician (PTCB)

- Behavior CompetenciesRequired: 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

#IH

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in**Scottsdale, AZ. ** This will be a Full-Time position.  This is a **remote hybrid opportunity, after onsite training period.**

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 $23.00 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 ExperienceRequired: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims AdjudicationDesired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience

- Work ExperienceRequired: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experienceDesired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience

- Skills/KnowledgeRequired: 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 skillsDesired: Knowledge of Foundation Funding, Specialty pharmacy experience

- Licenses/Certifications Required: Registration with Board of Pharmacy as required by state lawDesired: Certified Pharmacy Technician (PTCB)

- Behavior CompetenciesRequired: 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

**#Company Values: Teamwork, Respect, Integrity, Passion**

#IH

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in **New Hyde Park, NY. ** 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 $28.00 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

**#Company Values: Teamwork, Respect, Integrity, Passion **

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