Pharmacy Adjudication Specialist

Position: Pharmacy Adjudication Specialist Location: Louisville, KY (remote hybrid after onsite training). Shift time: 9:00 am–5:30 pm EST. Job Id: 687  # of Openings: 1 Starting salary: $21.00 per hour and up.  Sign-On Bonus: $5,000 for employees starting before July 31, 2026. Benefits 401(k) with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits – life, short‑term and long‑term disability Responsibilities Adjudicate pharmacy claims and review claim responses for accuracy; ensure prescription claims are adjudicated according to the coordination of benefits. Resolve third‑party rejections, obtain overrides when appropriate. Handle patient outreach, notifying them of delays in medication delivery due to insurance claim rejections. Practice first‑call resolution, answering questions and requests from health‑care providers and patients. Provide thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information. Ensure complete and accurate patient setup in CPR+ system including demographic and insurance information. Adjudicate pharmacy claims for prescriptions in active workflow for primary, secondary and tertiary pharmacy plans and review claim responses for accuracy before accepting the claim. Contact insurance companies to resolve third‑party rejections and ensure pharmacy claim rejections are resolved to allow for timely shipping of medications. Perform outreach calls to patients or providers to reschedule medication deliveries if claim resolution cannot be completed by the ship date and causes shipment delays. Ensure copay cards are only applied to eligible patients based on set criteria. Manage all funding related adjudications and liaise with the Onco360 Advocate team. Assist pharmacy team with management of 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; contact patients to communicate any copay discrepancy and collect payment if applicable. Document and submit requests for patient refunds when appropriate. Maintain a safe and clean pharmacy by complying with procedures, rules, regulations and professional practice and patient confidentiality laws. Contribute to team effort by accomplishing related tasks as needed and other duties as assigned. Conduct job responsibilities in accordance with the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws and professional standards. Qualifications 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: 1+ years experience in a pharmacy/health‑care setting or pharmacy claims experience. Desired: 3+ years experience in a pharmacy/health‑care setting or pharmacy claims experience. Skills/Knowledge 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 or healthcare‑related knowledge, understanding of pharmacy terminology including sig codes, Roman numerals, brand/generic names of medication, basic math and analytical skills, intermediate typing/keyboarding skills. Desired: Knowledge of Foundation Funding, specialty pharmacy experience. Licenses/Certifications Required: Registration with Board of Pharmacy as required by state law. Desired: Certified Pharmacy Technician (PTCB). Independent worker; good interpersonal skills; excellent verbal and written communications; ability to work independently, efficiently meet deadlines, flexible, detail‑oriented, great time‑management skills. Company Values #Company Values: Teamwork, Respect, Integrity, Passion #J-18808-Ljbffr