Pharmacy Claims Adjudication Specialist
for each section heading.
We must use - for any list of duties/requirements/benefits. Use
for prose.
We must preserve all substantive information, not invent or summarize away detail. Remove boilerplate etc. There's no cookie/navigation etc.
We need to ensure we don't include sections with placeholder text like "commensurate with experience". Not present.
We need to include Pay section only if posting actually states them: yes, salary and sign-on bonus.
Schedule: shift times between 8am and 8pm.
Benefits: list.
Now format.
We need to output only HTML fragment, no /, no markdown fences.
Let's craft.
First, About the role: combine intro sentences and company description.
Paragraph: "We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Buffalo, NY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers."
That's prose.
Responsibilities: list items from the responsibilities paragraph.
We need to extract each duty as list item.
The responsibilities text: "The Pharmacy Adjudication Specialist will 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, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360... 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 delaysEnsures 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 need to split into sensible list items. Could be many; but we must preserve all substantive information. We'll create
with each sentence as - . Ensure we don't lose details.
Let's split by periods (but careful with abbreviations). We'll approximate.
I'll create list items:
- Adjudicate pharmacy claims and review claim responses for accuracy.
- Ensure prescription claims are adjudicated correctly according to coordination of benefits.
- Resolve any third-party rejections and obtain overrides if appropriate.
- Be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections.
- Practice first call resolution to help health care providers and patients with pharmacy needs, answering questions and requests.
- 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 patient 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 ship date and causes shipment delays.
- Ensure copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible).
- Manage all funding related adjudications and work as a liaison to Onco360 Advocate team.
- Assist 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.
- Serve as customer service liaison to patients regarding financial responsibility prior to shipments, contact patients to communicate any copay discrepancy between quoted amount and claim 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, and regulations and compliance with 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 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.
That seems comprehensive.
Now Qualifications: includes Education/Learning Experience, Work Experience, Licenses/Certifications.
We need to list them maybe as
with subitems? Could just list each bullet.
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.
- Desired: Certified Pharmacy Technician.
- Desired: 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 into one list but better to keep sections? The instruction: Use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). They mention Requirements as a possible heading, but we can use Qualifications for education/experience/licenses. They also have Skills separate.
Thus we will have Qualifications section covering education, experience, licenses/certifications. Use - for each bullet.
Now Skills section: includes Skills/Knowledge and Behavior Competencies.
Skills/Knowledge:
- Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
- Desired: Knowledge of Foundation Funding, Specialty pharmacy experience.
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.
We'll list each as
- .
Now Benefits: list items.
Benefits list: 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.
We'll make each as
- .
Pay: Starting salary from $23.00 an hour and up; Sign-On Bonus: $5,000 for employees starting before October 31st, 2026.
We'll make
with two items.
Schedule: Shift times between 8am and 8pm. Also mention Full-Time, hybrid work style? Actually hybrid work style could be in About the role. Schedule section just shift times.
We'll output as maybe? But instruction: Use
- for any list of duties/requirements/benefits, and
for prose. Schedule is not a list; it's a statement. Could be
. But we could also make a
with one item; but better to use . However they said "Use
- for any list of duties/requirements/benefits". For schedule, not a list, so
.
Now ensure we don't repeat job title as heading. We'll not.
Now produce HTML:
About the role
...
Responsibilities
...
Qualifications
...
Skills
...
Benefits
...
Pay
...
Schedule
Shift times between 8am and 8pm.
Check for any missing info: hybrid work style and full-time mentioned in About the role? We included full-time and hybrid? We didn't include hybrid explicitly. Let's add to About the role: "This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style." We'll
for prose. We must preserve all substantive information, not invent or summarize away detail. Remove boilerplate etc. There's no cookie/navigation etc. We need to ensure we don't include sections with placeholder text like "commensurate with experience". Not present. We need to include Pay section only if posting actually states them: yes, salary and sign-on bonus. Schedule: shift times between 8am and 8pm. Benefits: list. Now format. We need to output only HTML fragment, no /, no markdown fences. Let's craft. First, About the role: combine intro sentences and company description. Paragraph: "We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Buffalo, NY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers." That's prose. Responsibilities: list items from the responsibilities paragraph. We need to extract each duty as list item. The responsibilities text: "The Pharmacy Adjudication Specialist will 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, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360... 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 delaysEnsures 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 need to split into sensible list items. Could be many; but we must preserve all substantive information. We'll create
- with each sentence as
- . Ensure we don't lose details.
Let's split by periods (but careful with abbreviations). We'll approximate.
I'll create list items:
- Adjudicate pharmacy claims and review claim responses for accuracy.
- Ensure prescription claims are adjudicated correctly according to coordination of benefits.
- Resolve any third-party rejections and obtain overrides if appropriate.
- Be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections.
- Practice first call resolution to help health care providers and patients with pharmacy needs, answering questions and requests.
- 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 patient 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 ship date and causes shipment delays.
- Ensure copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible).
- Manage all funding related adjudications and work as a liaison to Onco360 Advocate team.
- Assist 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.
- Serve as customer service liaison to patients regarding financial responsibility prior to shipments, contact patients to communicate any copay discrepancy between quoted amount and claim 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, and regulations and compliance with 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 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.
That seems comprehensive.
Now Qualifications: includes Education/Learning Experience, Work Experience, Licenses/Certifications.
We need to list them maybe as
- with subitems? Could just list each bullet.
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.
- Desired: Certified Pharmacy Technician.
- Desired: 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 into one list but better to keep sections? The instruction: Use
- for each bullet. Now Skills section: includes Skills/Knowledge and Behavior Competencies. Skills/Knowledge: - Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. - Desired: Knowledge of Foundation Funding, Specialty pharmacy experience. 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. We'll list each as
- . Now Benefits: list items. Benefits list: 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. We'll make each as
- .
Pay: Starting salary from $23.00 an hour and up; Sign-On Bonus: $5,000 for employees starting before October 31st, 2026.
We'll make
- with two items.
Schedule: Shift times between 8am and 8pm. Also mention Full-Time, hybrid work style? Actually hybrid work style could be in About the role. Schedule section just shift times.
We'll output as
- for any list of duties/requirements/benefits, and
for prose. Schedule is not a list; it's a statement. Could be
. But we could also make a
- with one item; but better to use
- for any list of duties/requirements/benefits". For schedule, not a list, so
. Now ensure we don't repeat job title as heading. We'll not. Now produce HTML:
About the role
...
Responsibilities
- ...
Qualifications
- ...
Skills
- ...
Benefits
- ...
Pay
- ...
Schedule
Shift times between 8am and 8pm.
Check for any missing info: hybrid work style and full-time mentioned in About the role? We included full-time and hybrid? We didn't include hybrid explicitly. Let's add to About the role: "This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style." We'll
. However they said "Use
- for any list of duties/requirements/benefits". For schedule, not a list, so
maybe? But instruction: Use
- for any list of duties/requirements/benefits, and
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). They mention Requirements as a possible heading, but we can use Qualifications for education/experience/licenses. They also have Skills separate. Thus we will have Qualifications section covering education, experience, licenses/certifications. Use