Pharmacy Insurance Rejections Specialist

City of Lincoln; Roanoke (VA); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k) with company match

Paid time off

Paid holidays

Short-term disability

Group life insurance

Job summary

SpecialtyRx, Inc. is seeking a Third-Party Rejections Specialist to join our billing team. This role focuses on hands-on third-party insurance rejection experience, researching, resolving, and processing pharmacy insurance rejections for long-term care facilities and associated providers.

Candidates must reside in Ohio, Virginia, or Kentucky and be able to work within a fast-paced billing environment, coordinating with insurers and care facilities to ensure accurate claims and timely resolutions.

Qualifications

• High school diploma or equivalent.
• Direct, hands-on experience working with third-party pharmacy insurance rejections is required.
• Experience must be in actual third-party rejection processing/resolution.
• Strong computer skills and ability to learn and navigate multiple systems.
• Excellent attention to detail and problem-solving skills.
• Professional and courteous telephone communication skills.
• Ability to work independently and as part of a team.
• Ability to multitask and prioritize work in a fast-paced environment.
• Strong organizational skills and follow-through.

Responsibilities

• Perform duties and responsibilities assigned by the Billing Supervisor.
• Research and verify patient eligibility and insurance coverage with state and private insurance providers.
• Research, analyze, and resolve third-party insurance rejections in accordance with daily rejection reports.
• Maintain and update patient billing, insurance, and coverage information in the system.
• Submit and follow up on prior authorizations for state insurance programs.
• Communicate directly with insurance companies regarding rejections, overrides, eligibility issues, coverage changes, and claim updates.
• Investigate and resolve pending billing and insurance issues.
• Work with client facility staff and other applicable healthcare organizations and agencies, including PDP/Medicare, CMS, NJM, and NYM, when necessary.
• Maintain accurate documentation and ensure billing information is current and complete.
• Work independently while collaborating with the billing team to meet daily goals and deadlines.
• Handle multiple priorities in a fast-paced environment while maintaining accuracy and attention to detail.

Skills

Third-party rejection handling

Insurance communications

Billing software navigation

Education

High school diploma or equivalent

Job description

SpecialtyRx, Inc. is seeking a Third-Party Rejections Specialist to join our billing team. This role focuses on hands-on third-party insurance rejection experience, researching, resolving, and processing pharmacy insurance rejections for long-term care facilities and associated providers.

Candidates must reside in Ohio, Virginia, or Kentucky and be able to work within a fast-paced billing environment, coordinating with insurers and care facilities to ensure accurate claims and timely resolutions.