Pharmacy Claims Adjudication- Supervisor
$60kOnco360
Onco360 Pharmac y has a need for qualified candidates to fill our role of Pharmacy Adjudication Supervisor . This is an e xcellent opportunity to join our company and help with our expanding Specialty Pharmacy program! This is a full-time position, Monday to Friday 9:30 am to 6:00 pm EST.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.
We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.
Salary range starting at $60k and up depending on experience
Sign-On Bonus: $5,000 for employees starting before October 31, 2026 We offer a variety of benefits including:
Education/Learning Experience
Work Experience
#IH Employment Type: Full Time
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.
We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.
Salary range starting at $60k and up depending on experience
Sign-On Bonus: $5,000 for employees starting before October 31, 2026 We offer a variety of benefits including:
- Medical; Dental; Vision
- 401k with a match
- Paid Time Off and Paid Holidays
- Quarterly Incentive Bonuses
- Tuition Reimbursement
- Company paid benefits - life insurance; and short and long-term disability
- Supervises adjudication staff in a leadership role to maintain a positive working environment by creating synergy and teamwork to minimize employee relations issues and reduce turnover. Communicates effectively across pharmacy and/or corporate teams and with patients, and successfully resolves issues.
- Assists Director of Pharmacy Operations in day-to-day pharmacy operations and in implementing new procedures to ensure that the accurate and timely dispensing of quality pharmacy services is consistently delivered to all patients using effective service leadership and customer skills.
- Works with pharmacy management to recruit, select, hire, orientate, develop, and train new associates. On an ongoing basis, evaluates, coaches, and utilizes performance management practices to motivate and set expectations for PA staff. In collaboration with management, drafts and delivers effective corrective action plans and disciplinary action to technicians performing at substandard levels.
- Manages and reports on daily activity of vertical team members, including monitoring of daily workflow and Pulse reporting.
- Handles escalations for difficult claim rejection resolution cases/questions to ensure accurate and timely completion of adjudication.
- Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
- Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays.
- Contacts insurance companies to follow up on prior authorization requests, including determining if any additional information is needed, or whether the claim is in review, approved, or denied. Document all prior authorization information in patient profile.
- Works with Pharmacy Technician Manager and/or Director of Pharmacy Operations on other responsibilities, projects, implementations, and initiatives as needed.
- Maintains a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
- Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
- Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Education/Learning Experience
- Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Knowledge of insurance and applicable regulations
- Desired: Associates or Bachelor's Degree, Certified Pharmacy Technician, Specialty pharmacy experience
Work Experience
- Required: 4+ years pharmacy or pharmacy adjudication or equivalent experience, previous leadership experience
- Desired: 5+ years pharmacy or pharmacy adjudication or equivalent experience, 1+ years supervisor experience, Specialty pharmacy experience
- Required: NDC medication billing, PBM and medical contracts, healthcare audit experience, knowledge of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, excellent interpersonal skills, able to work with all levels of management and staff, vast knowledge of pharmacy terminology and process including sig codes, and roman numerals, brand/generic names of medication, advanced typing, math and analytical skills.
- Desired: Specialty pharmacy operations, leadership skills, independent decision-making abilities, able to conduct research, be resourceful, and self-reliant, excellent communication skills
- Required: Registration with Board of Pharmacy as required by state law
- Desired: Certified Pharmacy Technician (PTCB), Advanced Certified Pharmacy Technician with completion of Billing and Reimbursement certification
- Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills, leadership
#IH Employment Type: Full Time
Vacancy posted 10 days ago
Similar jobs that could be interesting for youBased on the Pharmacy Claims Adjudication- Supervisor in Louisville, KY vacancy
- ...portfolio. This leadership role is responsible for setting strategy, guiding risk mitigation initiatives, and overseeing insurance and claims operations while managing and developing a dedicated risk management team. The position combines high-level program ownership with...SuggestedDaily paidImmediate startFlexible hours
$142.6k - $261.5k
...globe are investing heavily in technology-enabled transformation programs. A number of solution “hot spots” exist today, such as in claims, underwriting, policy and billing. Our ambition is to be the C-suite advisor for insurance technology-enabled transformation...SuggestedWork experience placementSummer holidayFlexible hoursEY
Louisville, KY4 days ago- A non-profit organization in Kentucky is seeking a Program Manager to implement the client's signature programs. This fully remote role requires the candidate to travel for events and collaborate closely with the Executive Director. Candidates should have 1-3+ years of...SuggestedRemote work
Insight Global
Louisville, KY13 hours ago $80k - $90k
...daily activities of the account management team. Customer Service: Handle customer service requests, policy administration, billing, claims, and coverage analysis. Policy Management: Manage policy expirations and renewals. Renewal Process: Conduct client research,...SuggestedRemote work- Allied Universal is hiring a Special Investigations Unit (SIU) Investigator to independently investigate suspected fraudulent insurance claims across workers’ compensation, general liability, property and casualty, and disability. The role emphasizes thorough documentation,...Suggested
- Job Title: Digital Banking ManagerOverview:As our Digital Banking Manager, you will set the vision and lead the evolution of our digital banking ecosystem—ensuring each interaction is intuitive, secure, and scalable. This role is well suited for a proven leader who operates...Bank staffLocal area
- Job Description Job Description Take control of your income, apply today to lock in top-tier contracts and access high-intent leads! Role Overview As a Licensed Life Insurance Agent & Agency Builder, your primary role is to connect qualified, high-intent prospects...Immediate start
$99k - $266k
The Opportunity As a Financial Services Tax - Real Estate Manager, you will play a pivotal role within our Tax practice, advising clients on their local and international tax affairs. You will act as a strategic consultant, helping organizations manage their tax obligations...H1bLocal areaPwC
Louisville, KY4 days ago- Job Description Job Description The Assurance Group is looking to hire a licensed and experienced Team Sales Manager with the right skill set for our National Marketing Organization. Although we will recruit experienced insurance agents for you, no experience ...Weekly payWork at office
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Pharmacy Claims Adjudication- Supervisor. Be the first to apply!
Related searches
- pharmacy director Louisville, KY
- property claims Louisville, KY
- claims processing Louisville, KY
- pharmacy claims Louisville, KY
- claims attorney Louisville, KY
- claims intake Louisville, KY
- veterans claims Louisville, KY
- medical claims auditor Louisville, KY
- healthcare claims Louisville, KY
- pharmacy internship Louisville, KY