Pharmacy Claims Adjudication Specialist
Onco360 Oncology Pharmacy · New Hyde Park, NY · 1 mo ago
Healthcare$26/hrFull-time
We need to output HTML fragment with sections: About the role? The posting includes description of role, responsibilities, qualifications, skills, benefits, pay, schedule. We must not repeat job title as heading. Use for section headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Include only sections with real content.
We need to parse the posting.
Content:
- Intro: "We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in New Hyde Park, NY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Shift times are between 8am and 8pm. Onco360 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 October 31st, 2026. We offer a variety of benefits including: Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits – life; and short and long-term disability"
So we have:
- About the role: description of role, location, hybrid, shift times, company description.
- Pay: Starting salary $26.00 an hour and up, Sign-On Bonus $5,000 for employees starting before Oct 31 2026.
- Benefits: list as above.
- Schedule: Shift times between 8am and 8pm (maybe also full-time). Could be schedule.
- Responsibilities: list of duties (the long paragraph after "Pharmacy Adjudication Specialist Major Responsibilities:").
- Qualifications: Education/Learning Experience, Work Experience, Licenses/Certifications, Behavior Competencies.
- Skills/Knowledge: Required and Desired.
We need to map to headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
We can combine Requirements and Qualifications? The instruction says use those headings if content exists. We'll have separate sections for Requirements (maybe covering education/experience/licenses) and Qualifications (maybe covering skills?). But they listed both Requirements and Qualifications as possible headings. We need to decide what goes where.
Typically: Requirements = education, experience, licenses. Qualifications = desired/required skills? But they also have Skills heading. Let's follow:
- About the role: intro description.
- Responsibilities: list of duties.
- Requirements: Education/Learning Experience, Work Experience, Licenses/Certifications, Behavior Competencies? Might be considered requirements.
- Qualifications: maybe "Desired" items? But we have Skills/Knowledge separate.
Better: Use Requirements for education/experience/licenses; Qualifications for desired/required skills? But they also have Skills heading. Hmm.
We could treat:
- Requirements: Education/Learning Experience, Work Experience, Licenses/Certifications.
- Qualifications: Behavior Competencies? Or maybe combine behavior with qualifications.
- Skills: Skills/Knowledge (Required and Desired).
But the instruction says "Prefer a few substantive sections over many thin ones." So we could combine some.
Let's think: The posting includes sections: "Education/Learning Experience", "Work Experience", "Skills/Knowledge", "Licenses/Certifications", "Behavior Competencies". We could map:
- Requirements: Education/Learning Experience + Work Experience + Licenses/Certifications (these are mandatory requirements).
- Qualifications: Behavior Competencies (maybe also desired education like Associate degree, Certified Pharmacy Technician, etc.) Actually those are under Education/Learning Experience Desired and Work Experience Desired. So those are also qualifications.
- Skills: Skills/Knowledge Required and Desired.
Thus we can have:
for section headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Include only sections with real content.
We need to parse the posting.
Content:
- Intro: "We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in New Hyde Park, NY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Shift times are between 8am and 8pm. Onco360 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 October 31st, 2026. We offer a variety of benefits including: Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits – life; and short and long-term disability"
So we have:
- About the role: description of role, location, hybrid, shift times, company description.
- Pay: Starting salary $26.00 an hour and up, Sign-On Bonus $5,000 for employees starting before Oct 31 2026.
- Benefits: list as above.
- Schedule: Shift times between 8am and 8pm (maybe also full-time). Could be schedule.
- Responsibilities: list of duties (the long paragraph after "Pharmacy Adjudication Specialist Major Responsibilities:").
- Qualifications: Education/Learning Experience, Work Experience, Licenses/Certifications, Behavior Competencies.
- Skills/Knowledge: Required and Desired.
We need to map to headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
We can combine Requirements and Qualifications? The instruction says use those headings if content exists. We'll have separate sections for Requirements (maybe covering education/experience/licenses) and Qualifications (maybe covering skills?). But they listed both Requirements and Qualifications as possible headings. We need to decide what goes where.
Typically: Requirements = education, experience, licenses. Qualifications = desired/required skills? But they also have Skills heading. Let's follow:
- About the role: intro description.
- Responsibilities: list of duties.
- Requirements: Education/Learning Experience, Work Experience, Licenses/Certifications, Behavior Competencies? Might be considered requirements.
- Qualifications: maybe "Desired" items? But we have Skills/Knowledge separate.
Better: Use Requirements for education/experience/licenses; Qualifications for desired/required skills? But they also have Skills heading. Hmm.
We could treat:
- Requirements: Education/Learning Experience, Work Experience, Licenses/Certifications.
- Qualifications: Behavior Competencies? Or maybe combine behavior with qualifications.
- Skills: Skills/Knowledge (Required and Desired).
But the instruction says "Prefer a few substantive sections over many thin ones." So we could combine some.
Let's think: The posting includes sections: "Education/Learning Experience", "Work Experience", "Skills/Knowledge", "Licenses/Certifications", "Behavior Competencies". We could map:
- Requirements: Education/Learning Experience + Work Experience + Licenses/Certifications (these are mandatory requirements).
- Qualifications: Behavior Competencies (maybe also desired education like Associate degree, Certified Pharmacy Technician, etc.) Actually those are under Education/Learning Experience Desired and Work Experience Desired. So those are also qualifications.
- Skills: Skills/Knowledge Required and Desired.
Thus we can have:
About the role
with intro.
Responsibilities
with list.
Requirements
with Education/Learning Experience (Required), Work Experience (Required), Licenses/Certifications (Required). Could also include Desired? Might be okay to include desired under Requirements as well but we can note.
Qualifications
with Desired Education (Associate degree, Certified Pharmacy Technician, Specialty pharmacy experience), Desired Work Experience (3+ years), Desired Skills/Knowledge (Foundation Funding, Specialty pharmacy experience), Desired Licenses/Certifications (Certified Pharmacy Technician). Also Behavior Competencies.
Skills
with Required Skills/Knowledge list and maybe also Desired? But we already placed desired under Qualifications. Might be duplication. Better to keep Skills for both required and desired skills, and Qualifications for behavior/competencies? Hmm.
Let's re-evaluate: The instruction list includes Skills as a possible heading. So we should have a Skills section for skills/knowledge. Qualifications could be for education/experience/licenses? Actually typical job postings: Qualifications = education, experience, certifications. Requirements = maybe skills? But they gave both headings. We need to decide.
Given the posting has explicit "Education/Learning Experience", "Work Experience", "Skills/Knowledge", "Licenses/Certifications", "Behavior Competencies". We could map:
- Requirements: Education/Learning Experience + Work Experience (required) + Licenses/Certifications (required). (These are mandatory.)
- Qualifications: Behavior Competencies (maybe also desired education/experience/licenses). But we could also put desired items under Qualifications.
- Skills: Skills/Knowledge (required and desired).
Thus we have four sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
We need to avoid thin sections; but we have enough content.
Now we need to format lists with - . For prose, use
.
We must not include boilerplate like EEO etc. Not present.
We must not repeat job title as heading.
We must not include Job ID/requisition numbers.
We must preserve all substantive information.
Let's extract details.
About the role:
- We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in New Hyde Park, NY.
- Full-Time position.
- Position must be located within driving distance to our pharmacy, with a hybrid work style.
- Shift times are between 8am and 8pm.
- Onco360 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 October 31st, 2026.
- We offer a variety of benefits including: Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits – life; and short and long-term disability
But benefits and pay/schedule may be separate sections. However the intro includes salary and bonus and benefits. We could still include them in About the role, but better to move to Pay, Benefits, Schedule sections as per instruction. The instruction says: include a section ONLY when the posting has real, specific content for it — never emit a heading followed by filler/placeholder text. So we should create Pay, Benefits, Schedule sections with the specific content.
Thus About the role should contain the descriptive parts: location, full-time, hybrid, shift times? Actually shift times go to Schedule. So About the role: description of role, location, hybrid, company description. Maybe also mention full-time.
Let's craft:
About the role:
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in New Hyde Park, NY. This is a Full-Time position with a hybrid work style, requiring the employee to be within driving distance of the pharmacy. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
That seems good.
Responsibilities: list of duties from "Pharmacy Adjudication Specialist Major Responsibilities:" onward until before "Pharmacy Adjudication Specialist Qualifications And Responsibilities..." Actually the responsibilities section includes many bullet-like sentences. We'll convert to - .
Let's extract responsibilities sentences:
- adjudicate pharmacy claims, review claim responses for accuracy.
- ensure prescription claims are adjudicated correctly according to the coordination of benefits
- resolve any third-party rejections
- obtain overrides if appropriate
- be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections
- Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
- Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.
- Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
- 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
- Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
- Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
- Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
- Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
- Documents and submit requests for Patient Refunds when appropriate.
- Maintain 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.
We'll put each as
- .
Now Requirements: Education/Learning Experience (Required), Work Experience (Required), Licenses/Certifications (Required). Also maybe include Behavior Competencies? But we'll put those under 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: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience.
Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience.
Licenses/Certifications Required: Registration with Board of Pharmacy as required by state law.
Desired: Certified Pharmacy Technician (PTCB).
We could combine required and desired under Requirements, but maybe better to separate required vs desired? The instruction doesn't require separating; just preserve all substantive info. We'll list both required and desired as separate
maybe.
But we need to avoid thin sections; we can combine.
Let's create Requirements section with two sub-lists: Required and Desired? But we cannot add extra headings inside? We could just list items with indication. Probably okay to include both.
We'll do:
Requirements
- Education/Learning Experience (Required): High School Diploma or GED; Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims
. We must not include boilerplate like EEO etc. Not present. We must not repeat job title as heading. We must not include Job ID/requisition numbers. We must preserve all substantive information. Let's extract details. About the role: - We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in New Hyde Park, NY. - Full-Time position. - Position must be located within driving distance to our pharmacy, with a hybrid work style. - Shift times are between 8am and 8pm. - Onco360 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 October 31st, 2026. - We offer a variety of benefits including: Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits – life; and short and long-term disability But benefits and pay/schedule may be separate sections. However the intro includes salary and bonus and benefits. We could still include them in About the role, but better to move to Pay, Benefits, Schedule sections as per instruction. The instruction says: include a section ONLY when the posting has real, specific content for it — never emit a heading followed by filler/placeholder text. So we should create Pay, Benefits, Schedule sections with the specific content. Thus About the role should contain the descriptive parts: location, full-time, hybrid, shift times? Actually shift times go to Schedule. So About the role: description of role, location, hybrid, company description. Maybe also mention full-time. Let's craft: About the role:
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in New Hyde Park, NY. This is a Full-Time position with a hybrid work style, requiring the employee to be within driving distance of the pharmacy. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
That seems good. Responsibilities: list of duties from "Pharmacy Adjudication Specialist Major Responsibilities:" onward until before "Pharmacy Adjudication Specialist Qualifications And Responsibilities..." Actually the responsibilities section includes many bullet-like sentences. We'll convert to- . Let's extract responsibilities sentences: - adjudicate pharmacy claims, review claim responses for accuracy. - ensure prescription claims are adjudicated correctly according to the coordination of benefits - resolve any third-party rejections - obtain overrides if appropriate - be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections - Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests. - Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information. - Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information. - 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 - Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible) - Manages all funding related adjudications and works as a liaison to Onco360 Advocate team. - Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment. - Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable. - Documents and submit requests for Patient Refunds when appropriate. - Maintain 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. We'll put each as
- .
Now Requirements: Education/Learning Experience (Required), Work Experience (Required), Licenses/Certifications (Required). Also maybe include Behavior Competencies? But we'll put those under 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: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience.
Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience.
Licenses/Certifications Required: Registration with Board of Pharmacy as required by state law.
Desired: Certified Pharmacy Technician (PTCB).
We could combine required and desired under Requirements, but maybe better to separate required vs desired? The instruction doesn't require separating; just preserve all substantive info. We'll list both required and desired as separate
- maybe.
But we need to avoid thin sections; we can combine.
Let's create Requirements section with two sub-lists: Required and Desired? But we cannot add extra headings inside? We could just list items with indication. Probably okay to include both.
We'll do:
- Education/Learning Experience (Required): High School Diploma or GED; Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims
Requirements