Supervisor - Pharmacy Adjudication

Pharmacy Adjudication Supervisor Onco360 Pharmacy is seeking a qualified Pharmacy Adjudication Supervisor to lead our expanding Specialty Pharmacy program. This is a full-time position (Monday – Friday, 9:30 am to 6:00 pm EST). Onco360 Pharmacy is a unique oncology pharmacy model serving community, oncology and hematology physicians, patients, payers, and manufacturers. A career with us is more than just a job – it offers an opportunity to connect and care for patients, providers, and communities. Salary: starting at $46k, depending on experience. Sign‑on bonus: $5,000 for employees starting before July 31, 2026. Benefits include medical, dental, vision, 401(k) match, paid time off and holidays, quarterly incentive bonuses, tuition reimbursement, company‑paid life insurance, and short/long‑term disability. Essential Functions Supervise adjudication staff, fostering a positive working environment, teamwork, low turnover, and resolving issues. Assist the Director of Pharmacy Operations with day‑to‑day pharmacy operations and implementing new procedures to ensure timely, accurate dispensing of quality pharmacy services. Recruit, select, hire, orient, develop, and train new associates; evaluate, coach, and employ performance‑management practices; create corrective action plans when necessary. Manage and report daily activity of vertical team members, monitoring workflow and Pulse reporting. Handle escalations for difficult claim rejection resolution cases to ensure accurate, timely completion. Adjudicate pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans; review claim responses for accuracy before acceptance. Contact insurance companies to resolve third‑party rejections and ensure timely shipping of medications; perform outreach calls to patients/providers to reschedule deliveries if required. Contact insurance companies for prior authorization requests, determining additional information needs; document all prior authorization information in patient profile. Collaborate with Pharmacy Technician Manager and/or Director of Pharmacy Operations on other responsibilities, projects, implementations, and initiatives as needed. Maintain a safe and clean pharmacy by complying with procedures, regulations, professional practice, and confidentiality laws. Contribute to team effort by accomplishing related tasks and other duties as assigned. Conduct job responsibilities in accordance with Company Code of Business Conduct and Ethics, policies, compliance agreements, federal/state laws, and professional standards. Qualifications 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: Associate’s 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. Skills / Knowledge 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, ability to work with all levels of management and staff, knowledge of pharmacy terminology and processes including sig codes, Roman numerals, brand/generic medication names, advanced typing, math and analytical skills. Desired: Specialty pharmacy operations, leadership skills, independent decision‑making abilities, ability to conduct research, resourceful, self‑reliant, excellent communication skills. Licenses / Certifications 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. Behavior Competencies Independent worker, good interpersonal skills, excellent verbal and written communication, ability to work independently and efficiently to meet deadlines, flexibility, detail‑oriented, great time‑management skills, leadership. #J-18808-Ljbffr JobRx, Inc.