pharmacy clinical specialist

Children's National Hospital

<div></div><div><div><b>Description</b><div>
</div>
The Clinical Pharmacy Specialist will serve within their area as the representative of pharmacy in all aspects of the care the<br>
<br>
pharmacy department provides. They will be responsible for review of pharmacy and organizational policies and procedures as<br>
<br>
they regard to drug use and departmental readiness for regulatory audits within and outside of their specialty area. They will<br>
<br>
provide oversight of formulary management (including development of guidelines and protocols) and drug-related education,<br>
<br>
work closely with other hospital departments to evaluate, direct, and modify pharmacy services, and assist in training of<br>
<br>
clinical staff and learners including competency assessments. The Clinical Pharmacy Specialist will also assist with oversight of<br>
<br>
the other pharmacy team members on their unit, when applicable. Academic scholarship will also be expected of this role<br>
<br>
including but not limited to authorship, presentations, and attendance at national meetings. The clinical pharmacy specialists<br>
<br>
will also be expected to help create and execute collaborative practice opportunities at Children's National.<div>
</div></div><div><b>
Qualifications</b><div>
</div><b>
Minimum Education</b><br>
Doctor of Pharmacy (Pharm.D.) Doctor of Pharmacy<br>
<br>
(Required)<br>
<br>
<b>Minimum Work Experience</b><br>
2 years At least a year of pharmacy experience in a pediatric, specialized or academic or clinical setting.
<br>
6 years required for candidates without a PGY2 residency. (Required)<br>
<br>
<b>Required Licenses and Certifications</b><br>
Pharmacist Eligible for Licensure in the District of Columbia plus/minus Maryland and Virginia (specialty dependent) 90 Days (Required) Board Certified Pharmacist (BPS) (specialty dependent) 1 Year (Required)<br>
<br>
<b>Functional Accountabilities</b><br>
<b>Order Processing and Accreditation Readiness</b><br>
<ul><li>
Interpret medication orders, profile orders and oversee the packaging, labeling and distribution of medications.
</li></ul><ul><li>Input orders into pharmacy computer system for area of practice when appropriate.
</li></ul><ul><li>Staff in the pharmacy operation to maintain distribution skillset.
</li></ul><ul><li>Assist in performing unit inspections and verifying accreditation readiness.
</li></ul><ul><li>Reviews medication lists for therapeutic duplication, omissions, dosing errors, drug interactions, and allergies.
</li></ul><ul><li>Reviews, interprets, and verifies new medication orders to ensure appropriate drug, dose, route, and frequency
</li></ul><ul><li>Assists nursing staff and other providers with automated dispensing machine questions.
</li></ul><b>Interventions/ Documentation</b><br>
<ul><li>
Perform drug therapy monitoring and intervene as necessary on drug dosing, drug administration, drug interactions, side-effects and monitoring issues.
</li></ul><ul><li>Complete therapeutic drug monitoring consults and adverse reaction reports.
</li></ul><ul><li>Document interventions and drug information.
</li></ul><ul><li>Document in patient chart when applicable and appropriate.
</li></ul><ul><li>Collaborates with multidisciplinary team to ensure appropriate medication access, including recommending alternative therapies as appropriate.
</li></ul><ul><li>Actively participates in the medication reconciliation process to ensure a complete and accurate home medication list.
</li></ul><ul><li>Works collaboratively with providers to implement and communicate comprehensive medication evaluation and management for patients including between care settings.
</li></ul><b>Staff Development and Training</b><br>
<ul><li>
Assist with the education, training, and general supervision of pharmacy students and residents.</li></ul><ul><li>
Assist with the training of new pharmacists.</li></ul><ul><li>
Provide lectures and drug reviews to various professional groups and committees.</li></ul><ul><li>
Develop system changes, educational programs and interventions that result in the reduction of errors in practice; including prescribing errors, dispensing errors, and administration errors.</li></ul><b>
Clinical Services</b><br>
<ul><li>
Take necessary steps to assure appropriate medication use throughout the organization.
</li></ul><ul><li>Identify drugs/therapies that should be considered for further evaluation and formulary addition.
</li></ul><ul><li>Provide accurate and timely drug information to physicians, nurses, and other health professionals.
</li></ul><ul><li>Maintain an active, current clinical practice based on evidence-based medicine.
</li></ul><ul><li>Serve as a clinical specialist resource for pharmacists, nurses and physicians; address and follow up on all issues related to systems and patient care.
</li></ul><ul><li>Assist the department in the management of drug shortages.
</li></ul><ul><li>Represent the Department on key committees.
</li></ul><ul><li>Assist pharmacy operations and informatics teams in implementation of new and updating of existing formulary items.
</li></ul><ul><li>Become credentialed and help to design, implement, and execute collaborative practice agreements.
</li></ul><b>Quality Improvement</b><br>
<ul><li>
Lead cost-savings initiatives within the department.
</li></ul><ul><li>Lead and participate in quality improvement initiatives both within the department and externally.
</li></ul><ul><li>Contribute to the development of order sets by helping devise, implement, and test electronic order set builds.
</li></ul><ul><li>Assist with the growth of clinical pharmacy programs throughout the organization.
</li></ul><ul><li>Actively participates in the development and implementation of performance/quality improvement and patient safety activities for service area, Pharmacy Services and the Enterprise (e.g. responds to RLs, participated in RCAs/ACAs).
</li></ul><ul><li>Identifies high-cost, high-use agents within defined area of practice and participates in cost management initiatives (revenue generating, cost containment, etc.).
</li></ul><b>Professional Development</b><br>
<ul><li>
Participate and/or lead research initiatives with medical unit and/or resident projects.</li></ul><ul><li>
Attend, present, and/or moderate at subject area conferences.</li></ul><ul><li>
Actively engage in preceptor development by attendings seminars, teaching in the Children&rsquo;s preceptor development series, and/or completing preceptor development CEs.</li></ul><ul><li>
Contribute to the primary literature by publication and/or poster presentations.</li></ul><br>
<b>
Organizational Accountabilities</b><br>
<b>Organizational Accountabilities (Staff)</b><br>
<b>Organizational Commitment/Identification
</b><ul><li>Anticipate and responds to customer needs; follows up until needs are met</li></ul><br>
Teamwork/Communication
<ul><li>Demonstrate collaborative and respectful behavior</li></ul><ul><li>
Partner with all team members to achieve goals</li></ul><ul><li>
Receptive to others&rsquo; ideas and opinions</li></ul><br>
Performance Improvement/Problem-solving
<ul><li>Contribute to a positive work environment</li></ul><ul><li>
Demonstrate flexibility and willingness to change</li></ul><ul><li>
Identify opportunities to improve clinical and administrative processes</li></ul><ul><li>
Make appropriate decisions, using sound judgment</li></ul><br>
Cost Management/Financial Responsibility
<ul><li>Use resources efficiently</li></ul><ul><li>
Search for less costly ways of doing things</li></ul><br>
Safety
<ul><li>Speak up when team members appear to exhibit unsafe behavior or performance</li></ul><ul><li>
Continuously validate and verify information needed for decision making or documentation</li></ul><ul><li>
Stop in the face of uncertainty and takes time to resolve the situation</li></ul><ul><li>
Demonstrate accurate, clear and timely verbal and written communication</li></ul><ul><li>
Actively promote safety for patients, families, visitors and co-workers</li></ul><ul><li>
Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance</li></ul><div>
</div></div><div><b>
Primary Location</b><b>:</b> District of Columbia-Washington</div><div><b>
Work Locations</b><b>:</b> CN Hospital (Main Campus) 111 Michigan Avenue NW Washington 20010</div><div><b>
Job</b><b>:</b> Allied Health</div><div><b>
Organization</b><b>:</b> Patient Services</div><div><b>
Position Status</b><b>:</b> R (Regular) - O - PRN</div><div><b>
Shift</b><b>:</b> Variable</div><div><b>
Work Schedule</b><b>:</b> Var</div><div><b>
Job Posting</b><b>:</b> Jun 12, 2026, 5:49:03 PM</div><div><b>
Full-Time Salary Range</b><b>:</b> 115731.2 - 192878.4</div></div>

Clinical Pharmacy Specialist - PRN

Rush University Medical Center

<p></p><div><p><b>Location: </b>Chicago, Illinois
</p><p><b>Business Unit: </b>Rush Medical Center
</p><p><b>Hospital: </b>Rush University Medical Center
</p><p><b>Department: </b>Pharmacy
</p><p><b>Work Type: </b>Full Time (Total FTE between 0.9 and 1.0)
</p><p><b>Shift: Shift 3
</b></p><p><b>Work Schedule: </b>10 Hr (9:00:00 PM - 7:00:00 AM)
</p><p><b>Rush offers exceptional rewards and benefits learn more at our </b>Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits).
</p><p><b>Pay Range: </b>$53.73 - $84.63 per hour
<br>
Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush&rsquo;s anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case.
</p><p>Summary:
</p><p>The Clinical Pharmacy Specialist, Emergency Medicine, provides direct patient care in the Emergency Department (ED), serving both pediatric and adult populations. The individual mus demonstrate maturity, independence, initiative, and strong communication skills while exemplifying the Rush mission, vision, and values and acts in accordance with Rush policies and procedures.
</p><p>Other information:
<br>
Required Job Qualifications:<br>
<br>
</p><ul><li>Bachelor of Science in Pharmacy.
</li><li>Illinois Pharmacist License.
</li><li>Minimum of four years of Clinical Pharmacy experience OR PGY 1 residency completed within the last seven years, which includes Clinical / Specialty Pharmacy experience.
</li><li>Knowledge in intravenous admixture services, intravenous drug therapy and chemotherapy.
</li><li>Must be able to work effectively with others to provide safe and effective drug therapy.
</li><li>Excellent problem-solving skills and the ability to work independently and quickly in responding to and resolving a wide range of problems.
</li></ul><br>
Preferred Job Qualifications:
<br>
<ul><li>BLS Certification.
</li><li>ACLS Certification (or shall be obtained upon hire).
</li><li>Board of Pharmaceutical Specialties Board Certification.
</li><li>Doctor of Pharmacy degree and residency certificate.
</li><li>Experience and strong knowledge base in specialty drug therapies.
</li></ul><p>Responsibilities:
</p><p></p><ul><li>This position primarily covers overnight shifts (21:00&ndash;07:00) on a 7-on/7-off schedule.
</li><li>Additional responsibilities may include coverage of intensive care units (ICUs), Central Pharmacy, and remote medication order verification for other EDs within the health system, based on departmental needs.
</li><li>Weekend coverage follows every other weekend rotation.
</li><li>Holiday staffing is required.
</li><li>Evaluates and verifies medication orders in Epic for therapeutic appropriateness, dosing accuracy, optimal dosage form, drug interactions, allergies, route and rate of administration, and therapeutic duplication.
</li><li>Clarifies physicians&rsquo; orders as needed through timely communication with prescribers or designated practitioners.
</li><li>Provides patient-specific pharmacotherapy recommendations and drug information to medical and nursing staff.
</li><li>Participates in emergency response activities, including cardiac arrest, respiratory arrest, and stroke interventions.
</li><li>Precepts pharmacy students and residents (PGY1 and PGY2; including PGY2 EM program) in both clinical and operational areas, as assigned.
</li><li>Performs daily review of pharmacy reports, including pharmacokinetic monitoring and other patient-specific or medication-related reports.
</li><li>Documents clinical interventions using department-approved systems.
</li><li>Provides discharge counseling and ensures appropriate follow-up of culture results when applicable.
</li><li>Supervises pharmacy technicians involved in medication preparation and delivery, ensuring coordination with established workflows and schedules.
</li><li>Coordinates medication ordering, preparation, dispensing, and administration processes for assigned patient populations.
</li><li>Conducts monthly inspections of medication storage areas in assigned nursing units.
</li><li>Implements formulary and medication-use policies established by the System Pharmacy and Therapeutics Committee.
</li><li>Participates in medication safety initiatives, including reporting of adverse drug reactions (ADRs) and medication errors.
</li><li>Leads or contributes to clinical, operational, and quality improvement projects aligned with departmental priorities (e.g., automation optimization, workflow improvements).
</li><li>Evaluates and interprets medical and pharmaceutical literature to support evidence-based practice and formulary decisions.
</li><li>Collaborates with interdisciplinary teams to optimize patient care and medication management.
</li><li>Serves as a liaison with other departments to support research, education, and quality initiatives.
</li><li>Evaluates and monitors drug therapy in collaboration with physicians, nurses, and other healthcare professionals to ensure safe and effective patient outcomes.
</li><li>Collaborates closely with the Emergency Medicine medical residency program.
</li></ul><p></p><p>Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.</p></div>

Clinical Pharmacy Specialist

US Department of Veterans Affairs

Pharmacist (Clinical Pharmacy Specialist) - Ambulatory Care

CareMed Specialty Pharmacy

<div><div>We are seeking a Pharmacy Adjudication Specialist at our <b>CareMed Specialty Pharmacy</b> in<b> New Hyde Park, NY. </b>This will be a Full-Time position.<b> </b>This is a <b>remote hybrid opportunity, after onsite training period.</b></div>
<div></div><div><div><b>Shift time currently available: 9:00 am-5:30 pm EST</b></div>
<div></div><div><b>Starting salary from $26.00 an hour and up</b></div>
</div><div></div><div><b>Sign-On Bonus: </b><b>$5,000 for employees starting before July 31, 2026.</b></div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Company paid benefits &ndash; life; and short and long-term disability</li>
</ul><div><b>Pharmacy Adjudication </b><b>Specialist Major Responsibilities:</b></div>
<div>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</div>
<div></div><div>Pharmacy Adjudication Specialists at CareMed...</div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>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.</li>
<li>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</li>
<li>Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)</li>
<li>Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.</li>
<li>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.</li>
<li>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.</li>
<li>Documents and submit requests for Patient Refunds when appropriate.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul><div>Pharmacy Adjudication Specialist Qualifications and Responsibilities...</div>
<div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Work Experience
<ul><li>Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
<li>Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
</ul></li></ul><ul><li>Skills/Knowledge
<ul><li>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</li>
<li>Desired: Knowledge of Foundation Funding, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Licenses/Certifications
<ul><li>Required: Registration with Board of Pharmacy as required by state law</li>
<li>Desired: Certified Pharmacy Technician (PTCB)</li>
</ul></li></ul><ul><li>Behavior Competencies
<ul><li>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</li>
</ul></li></ul><div><b>#Company Values: Teamwork, Respect, Integrity, Passion</b></div></div></div><div></div>

Pharmacy Adjudication Specialist

Onco360

<div><div>We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in<b> Scottsdale, AZ. </b>This will be a Full-Time position.<b> </b>This is a <b>remote hybrid opportunity, after onsite training period.</b></div>
<div></div><div><div><b>Shift time currently available: 8:30 am-5:00 pm MST</b></div>
<div></div><div>Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.</div>
</div>
<div></div><div><b>Starting salary from $23.00 an hour and up</b></div>
<div><b>Sign-On Bonus: </b><b>$5,000 for employees starting before July 31, 2026.</b></div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Company paid benefits &ndash; life; and short and long-term disability</li>
</ul><div><b>Pharmacy Adjudication </b><b>Specialist Major Responsibilities:</b></div>
<div>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</div>
<div></div><div>Pharmacy Adjudication Specialists at Onco360...</div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>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.</li>
<li>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</li>
<li>Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)</li>
<li>Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.</li>
<li>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.</li>
<li>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.</li>
<li>Documents and submit requests for Patient Refunds when appropriate.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul><div>Pharmacy Adjudication Specialist Qualifications and Responsibilities...</div>
<div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Work Experience
<ul><li>Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
<li>Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
</ul></li></ul><ul><li>Skills/Knowledge
<ul><li>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</li>
<li>Desired: Knowledge of Foundation Funding, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Licenses/Certifications
<ul><li>Required: Registration with Board of Pharmacy as required by state law</li>
<li>Desired: Certified Pharmacy Technician (PTCB)</li>
</ul></li></ul><ul><li>Behavior Competencies
<ul><li>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</li>
</ul></li></ul><div><b>#Company Values: Teamwork, Respect, Integrity, Passion</b></div>
<div></div><div>#IH</div></div></div>

Pharmacy Claims Adjudication Specialist

<div><div>We are seeking a Pharmacy Adjudication Specialist at our <b>CareMed Specialty Pharmacy</b> in<b> Waltham, MA. </b>This will be a Full-Time position.<b> </b>This is a <b>remote hybrid opportunity, after onsite training period.</b></div>
<div></div><div><div><b>Shift time currently available: 9:00 am-5:30 pm CST</b></div>
<div></div><div><b>Starting salary from $26.00 an hour and up</b></div>
</div><div></div><div><b>Sign-On Bonus: </b><b>$5,000 for employees starting before July 31, 2026.</b></div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Company paid benefits &ndash; life; and short and long-term disability</li>
</ul><div><b>Pharmacy Adjudication </b><b>Specialist Major Responsibilities:</b></div>
<div>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</div>
<div></div><div>Pharmacy Adjudication Specialists at CareMed...</div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>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.</li>
<li>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</li>
<li>Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)</li>
<li>Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.</li>
<li>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.</li>
<li>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.</li>
<li>Documents and submit requests for Patient Refunds when appropriate.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul><div>Pharmacy Adjudication Specialist Qualifications and Responsibilities...</div>
<div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Work Experience
<ul><li>Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
<li>Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
</ul></li></ul><ul><li>Skills/Knowledge
<ul><li>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</li>
<li>Desired: Knowledge of Foundation Funding, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Licenses/Certifications
<ul><li>Required: Registration with Board of Pharmacy as required by state law</li>
<li>Desired: Certified Pharmacy Technician (PTCB)</li>
</ul></li></ul><ul><li>Behavior Competencies
<ul><li>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</li>
</ul></li></ul><div><b>#Company Values: Teamwork, Respect, Integrity, Passion</b></div></div></div><div></div>

<div><div>We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in <b>Buffalo, NY. </b>This will be a Full-Time position.<b> This position must be located within driving distance to our pharmacy, with a hybrid work style.</b></div>
<div></div><div><div><b>Shift times currently available: 10:00 am to 6:30 pm EST</b></div>
<div></div><div>Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.</div>
</div>
<div></div><div><b>Starting salary from $23.00 an hour and up</b></div>
<div><b>Sign-On Bonus: </b><b>$5,000 for employees starting before July 31, 2026.</b></div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Company paid benefits &ndash; life; and short and long-term disability</li>
</ul><div><b>Pharmacy Adjudication </b><b>Specialist Major Responsibilities:</b></div>
<div>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</div>
<div></div><div>Pharmacy Adjudication Specialists at Onco360...</div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>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.</li>
<li>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</li>
<li>Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)</li>
<li>Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.</li>
<li>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.</li>
<li>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.</li>
<li>Documents and submit requests for Patient Refunds when appropriate.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul><div>Pharmacy Adjudication Specialist Qualifications and Responsibilities...</div>
<div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Work Experience
<ul><li>Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
<li>Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
</ul></li></ul><ul><li>Skills/Knowledge
<ul><li>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</li>
<li>Desired: Knowledge of Foundation Funding, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Licenses/Certifications
<ul><li>Required: Registration with Board of Pharmacy as required by state law</li>
<li>Desired: Certified Pharmacy Technician (PTCB)</li>
</ul></li></ul><ul><li>Behavior Competencies
<ul><li>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</li></ul></li></ul></div></div>

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