Job Summary
The Pharmacy Claims Adjudication Specialist plays a crucial role in assessing and processing pharmacy claims while addressing any third-party rejections. This position ensures the proper coordination of benefits and is instrumental in communicating with patients about medication delivery challenges. Additionally, the specialist acts as a point of contact for inquiries related to financial responsibilities.
Responsibilities
- Adjudicate pharmacy claims effectively to facilitate timely processing.
- Resolve third-party claim rejections to ensure a smooth workflow.
- Coordinate benefits accurately among various insurance providers.
- Manage patient outreach concerning delays in medication delivery.
- Liaise with patients regarding questions about financial obligations and responsibilities.
Qualifications
- High School Diploma or GED is required.
- A minimum of 2 years of experience in a pharmacy or healthcare environment.
- Strong proficiency in pharmacy claims adjudication processes.
- Solid understanding of insurance regulations and requirements.
- Excellent analytical and communication skills are essential.
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.
