Pharmacy Claims Adjudication Specialist

Pharmacy Claims Adjudication Specialist – Onco
360 Oncology Pharmacy

We are seeking a Pharmacy Adjudication Specialist at our specialty pharmacy in Scottsdale, AZ. This is a full‑time position with a remote hybrid opportunity after an onsite training period.

Onco
360 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. Sign‑On Bonus: $5,000 for employees starting before February 1, 2026.

Seniority level:
Entry level.

Employment type:

Full-time.

Job function:
Healthcare Provider;
Industry: Pharmaceutical Manufacturing.

• Medical;
  Dental;
  Vision
• 401(k) with a match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Life Insurance
• Short‑ and long‑term disability

• Adjudicate pharmacy claims, review claim responses for accuracy, ensure prescription claims are adjudicated correctly according to the coordination of benefits.
• Resolve third‑party rejections, obtain overrides if appropriate.
• Perform patient outreach for claims delays and coordinate medication delivery.
• Handle first‑call resolution for healthcare providers and patients, answering pharmacy related questions.
• Ensure complete and accurate patient setup in CPR+ system (demographics, insurance).
• Contact insurance companies to resolve rejections and facilitate timely shipment of medications.
• Verify copay card eligibility and manage funding adjudications.
• Coordinate electronically adjudicated claims, reconcile prescription assessments, and charge copay payments prior to shipment.
• Serve as customer service liaison for financial responsibility, communicate copay discrepancies, collect payments.
• Document and submit patient refund requests when appropriate.

• Education / Learning Experience
  • Required:
    
    High School Diploma or GED; prior experience in pharmacy, medical billing, benefit verification, or pharmacy claims adjudication.
  • Desired:
    Associate degree or equivalent;
    Certified Pharmacy Technician; specialty pharmacy experience.
• Work Experience
  • Required:
    
    1+ years in pharmacy/healthcare setting or pharmacy claims experience.
  • Desired: 3+ years in similar role.
• Skills / Knowledge
  • Required:
    
    Pharmacy/NDC medication billing, pharmacy claims resolution, PBM and medical contracts, Medicare, Medicaid, commercial insurance knowledge, NCPDP claim rejection resolution, coordination of benefits, pharmacy terminology, basic math, intermediate typing/keyboarding.
  • 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
  • Independent worker, good interpersonal skills, excellent verbal and written communication.
  • Efficiently meeting deadlines, flexibility, detail‑oriented, great time‑management.

Teamwork, Respect, Integrity, Passion