Pharmacy Claims Adjudication Specialist

We are seeking a Pharmacy Adjudication Specialist for our Specialty Oncology pharmacy.

Full‑time position based in Ohio, with remote work options. Shift times: 9:00 am–5:30 pm EST or 10:00 am–6:30 pm EST. Starting hourly salary: $25.00 and up. Sign‑on bonus: $5,000 for employees starting before July 31, 2026.

• Medical, Dental, Vision
• 401(k) with match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Life, short, and long‑term disability (company paid)

• Adjudicate pharmacy claims and review claim responses for accuracy.
• Ensure prescription claims are adjudicated correctly according to coordination of benefits, resolve third‑party rejections, and obtain overrides when appropriate.
• Perform patient outreach to notify about delays due to insurance claim rejections and coordinate rescheduling of medication deliveries.
• Practice first‑call resolution for healthcare providers and patients, answering questions and requests.
• Maintain accurate patient setup in CPR+ system, including demographics and insurance information.
• Contact insurance companies to resolve third‑party rejections and ensure claims are cleared before shipment.
• Verify copay card eligibility, apply to eligible claims, and manage all funding‑related adjudications.
• Assist with reconciliations of electronically adjudicated claims and copay payments before shipment.
• Act as customer service liaison for financial responsibility, including communicating copay discrepancies and collecting payment when needed.
• Document and submit requests for patient refunds as appropriate.
• Comply with all applicable laws, regulations, policies, and professional standards.
• Contribute to the team as required and perform additional duties as assigned.

• Education
  • Required:
    
    High School Diploma or GED.
  • Desired:
    Associate degree from a 2‑year program or technical school, Certified Pharmacy Technician, or specialty pharmacy experience.
• Work Experience
  • Required:
    
    2+ years in pharmacy or healthcare setting, or pharmacy claims experience.
  • Desired: 3+ years in pharmacy or healthcare setting, or pharmacy claims experience.
• Skills & Knowledge
  • Required:
    
    Pharmacy/NDC billing, claims resolution, PBM and medical contracts, Medicare, Medicaid, and commercial insurance knowledge, NCPDP claim rejection resolution, coordination of benefits, pharmacy terminology, basic math, and typing skills.
  • Desired:
    Knowledge of Foundation Funding and specialty pharmacy experience.
• Licenses & Certifications
  • Required:
    
    Pharmacy Technician License/Registration with Board of Pharmacy as required by state law.
• Behavioral Competencies
  • Required:
    
    Independent worker, strong interpersonal, verbal and written communication skills, ability to work efficiently, detail‑oriented, excellent time‑management.