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Supervisor - Pharmacy Adjudication Onco360 - 3.5 Waltham, MA Job Details Full-time From $54,000 a year 3 hours ago Benefits Paid holidays Disability insurance Health insurance Dental insurance Tuition reimbursement Paid time off Vision insurance 401(k) matching Life insurance Qualifications Customer communication Medicare Commercial insurance knowledge Pharmacy Technician License Quality control audit High school diploma or GED Math Registered Pharmacy Technician Medicaid Typing Medical billing regulations compliance Medical terminology Full Job Description Onco360 Pharmac y has a need for qualified candidates to fill our role of Pharmacy Adjudication Supervisor . This is an excellent 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 $54k 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 The Pharmacy Adjudication Supervisor is responsible for all aspects of pharmacy claims adjudication, accuracy of pharmacy claims, resolution of third-party rejections, coordination of benefits, and patient outreach regarding any delay in medication delivery due to insurance claim rejections. This role requires advanced program knowledge and will provide quality control by routinely examining cases completed by team members.

Adjudication Supervisor Essential Functions :

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.

Adjudication Supervisor 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:

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

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, 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

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 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