Pharmacy Claims Adjudication Specialist

Join to apply for the Pharmacy Claims Adjudication Specialist role at Onco
360 Oncology Pharmacy
.

This is a full‑time hybrid position located within driving distance of our Houston, TX pharmacy.

Starting salary: $20.00 an hour and up. Sign‑On Bonus: $5,000 for employees starting before February 1, 2026.

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

• Adjudicate pharmacy claims and review claim responses for accuracy.
• Ensure prescription claims are adjudicated correctly according to the coordination of benefits.
• Resolve third‑party rejections, obtain overrides when appropriate.
• Initiate patient outreach notifications regarding delays due to insurance claim rejections.
• Provide first‑call resolution to health care providers and patients with pharmacy needs.
• Ensure complete and accurate patient setup in CPR+ system, including demographic and insurance information.
• Contact insurance companies to resolve third‑party rejections and ensure claims are cleared for timely medication shipment.
• Perform outreach calls to patients or providers to reschedule medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays.
• Apply copay cards only to eligible patients based on set criteria.
• Manage all funding‑related adjudications and liaise with the Onco
  360 Advocate team.
• Assist the pharmacy team with electronically adjudicated claims to ensure prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
• Serve as customer service liaison to patients regarding financial responsibility prior to shipments, communicate any copay discrepancies, and collect payment if applicable.
• Document and submit requests for patient refunds when appropriate.

• Required:
  
  High School Diploma or GED; prior experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication.
• Desired:
  Associate degree or equivalent program, Certified Pharmacy Technician, Specialty pharmacy 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.

• Required:
  
  Pharmacy/NDC medication billing;
  Pharmacy claims resolution; PBM and Medical contracts; knowledge of Medicare, Medicaid, and commercial insurance; NCPDP claim rejection resolution; coordination of benefits; pharmacy terminology; basic math and analytical skills; intermediate typing/keyboarding skills.
• Desired:
  Knowledge of Foundation Funding;
  Specialty pharmacy experience.

• Required:
  
  Registration with Board of Pharmacy as required by state law.
• Desired:
  Certified Pharmacy Technician (PTCB).

• Independent worker with good interpersonal skills.
• Excellent verbal and written communication skills.
• Ability to work efficiently, meet deadlines, and be flexible.
• Detail‑oriented with great time‑management skills.

#Company Values:
Teamwork, Respect, Integrity, Passion

Location:

Houston, TX