Pharmacy Claims Adjudication Specialist - Onco360 : Job Details

Join to apply for the Pharmacy Claims Adjudication Specialist role at Onco360 Oncology Pharmacy1 week ago Be among the first 25 applicantsJoin to apply for the Pharmacy Claims Adjudication Specialist role at Onco360 Oncology PharmacyGet AI-powered advice on this job and more exclusive features.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 $21.00 an hour and upWe offer a variety of benefits including:Medical; Dental; Vision401k with a matchPaid Time Off and Paid HolidaysTuition ReimbursementCompany paid benefits – life; and short and long-term disabilityPharmacy 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 rejectionsPharmacy 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 delaysEnsures 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 experienceWork ExperienceRequired: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experienceDesired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experienceSkills/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 experienceLicenses/CertificationsRequired: 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 skillsSeniority level Seniority level Entry levelEmployment type Employment type Full-timeJob function Job function Health Care ProviderIndustries Pharmaceutical ManufacturingReferrals increase your chances of interviewing at Onco360 Oncology Pharmacy by 2xGet notified about new Pharmacy Specialist jobs in Buffalo, NY .Buffalo, NY $120,000.00-$135,000.00 1 month agoPharmacy Support Associate (Part Time, $18/hr + $1.00 Shift Dif) Pharmacist – Relocation Opportunity with Financial Assistance! 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