Job Summary
The Pharmacy Adjudication Specialist plays a crucial role in managing and adjudicating pharmacy claims while addressing third-party rejection issues. This position is key in ensuring the precise coordination of benefits, facilitating patient communication regarding possible delays in medication delivery, and acting as a link for any discrepancies in financial responsibility and copayment amounts.
Responsibilities
- Adjudicate pharmacy claims and resolve any third-party denials.
- Ensure accurate coordination of benefits for patients.
- Conduct patient outreach to inform them about medication delivery delays.
- Act as a liaison regarding financial responsibilities and copayment discrepancies.
Qualifications
- High School Diploma or GED is required.
- A minimum of 2 years of experience in a pharmacy or healthcare environment.
- Proficiency in pharmacy claims resolution and a solid understanding of insurance processes.
- Basic math skills are essential for effective claim adjudication.
- Must possess state-mandated Board of Pharmacy registration.
Onco360 provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
