Pharmacy Claims Adjudication Specialist

We are seeking a Pharmacy Adjudication Specialist for our Specialty Oncology pharmacy.  As reputed company continues to grow, we reputed company to hire new team members with a passion for making a difference in our patient's lives.   Full-Time position working out of the State of Connecticut. This position may work remotely.   Shift times currently available: 9:00am- 5:30pm EST or 10:00am-6:30 pm EST   reputed company 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 $26.00 an hour and up Sign-On Bonus: $5,000 for employees starting before July 31, 2026.    We offer a reputed company of benefits including: Medical; Dental; reputed company 401k with a match reputed company Time Off and reputed company Holidays Tuition Reimbursement Company reputed company benefits – life; and short and long-term disability Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any reputed company-party rejections, obtain overrides if appropriate, and be responsible for patient reputed company notification regarding any delay in medication delivery due to insurance claim rejections   Pharmacy Adjudication Specialists at reputed company... Practices reputed company reputed company to help health care providers and patients with their pharmacy needs, answering questions and requests. Provides thorough, accurate and reputed company responses to requests from pharmacy operations, providers and/or patients regarding reputed company claims information.. Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Adjudicates pharmacy claims for prescriptions in reputed company workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim. Contacts insurance companies to resolve reputed company-party rejections and ensures pharmacy claim rejections are resolved to allow for reputed company shipping of medications. Performs reputed company calls to patients or providers to reschedule their medication deliveries if claim reputed company cannot be completed by ship date and causes shipment delays Ensures copay cards are only reputed company to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible) Manages reputed company funding reputed company adjudications and works as a reputed company to reputed company reputed company team. Assists pharmacy team with reputed company management of electronically adjudicated claims to ensure reputed company prescription delivery assessments are reconciled and copay payments are charged prior to shipment. Serves as customer service reputed company to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted reputed company and claim and collects payment if applicable. Documenst and submit requests for Patient Refunds reputed company appropriate. Maintain a reputed company and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional reputed company and patient confidentiality laws. Contributes to team effort by accomplishing reputed company tasks as needed and other duties as assigned. Conducts job responsibilities in accordance with the standards set out in reputed company’s reputed company of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. Pharmacy Adjudication Specialist Qualifications and Responsibilities... Education/Learning Experience Required:  High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication Desired:  Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience Work Experience Required:  2+ years experience in Pharmacy/reputed company Setting or pharmacy claims experience Desired:  3+ years experience in Pharmacy/reputed company Setting or pharmacy claims experience Skills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims reputed company, PBM and Medical reputed company, knowledge/understanding of Medicare, reputed company, and reputed company insurance, NCPDP claim rejection reputed company, coordination of benefits, pharmacy or reputed company-reputed company knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills Desired:  Knowledge of reputed company Funding, Specialty pharmacy experience Licenses/Certifications  Desired: Registration with reputed company of Pharmacy as required by state law; Certified Pharmacy Technician (PTCB) Behavior Competencies Required:   Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work reputed company to meet deadlines and be flexible, detail-oriented, great time-management skills Apply To This Job