3rd Party Rejection Specialist - Remote

Overview

As a 3rd Party Rejection Specialist, you will support pharmacy operations by identifying, investigating, and resolving third-party insurance claim rejections, ensuring timely patient access to medications while minimizing financial loss for the pharmacy.

In Short

• Support pharmacy operations by resolving third-party insurance claim rejections.
• Review rejected insurance claims via the pharmacy's billing or POS system.
• Identify rejection codes and determine the root cause.
• Communicate with prescriber offices for missing documentation.
• Follow up with patients regarding their insurance information.
• Track rejection cases and resolution outcomes using internal logs.
• Escalate unresolved issues to the supervising pharmacist.
• Maintain HIPAA-compliant documentation.
• Support billing, claim resubmission, and reporting tasks.
• Work during U.S. business hours, either full-time or part-time.

Requirements

• Proven experience in pharmacy billing or claims processing.
• Strong understanding of U.S. pharmacy claim workflows.
• Familiarity with rejection codes and insurance terminology.
• Excellent English communication skills.
• Detail-oriented with strong organisational skills.
• HIPAA certification or willingness to obtain one.
• Knowledge of pharmacy software like PioneerRx or QS/1 is a plus.

Benefits

• Opportunity to work remotely.
• Flexible work schedule (full-time or part-time).
• Supportive work environment.
• Gain experience in pharmacy operations.
• Potential for professional development in healthcare.