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Competitive Pay Stable Schedules Career Growth Multiple Shifts Available
SpecialtyRx is a fast-growing Long-Term Care pharmacy dedicated to providing personalized, high-quality pharmaceutical services to long-term care facilities and assisted living communities.
We are currently seeking a Third-Party Rejections Specialist to join our team. This role is focused specifically on hands-on third-party insurance rejection experience. If you have direct experience researching, resolving, and processing pharmacy insurance rejections, we want to hear from you!
Candidates must reside in Ohio, Virginia, or Kentucky.
What You'll Do
- 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.
Qualifications
Who We're Looking For
We're looking for detail-oriented professionals who understand how to work through third-party pharmacy claim rejections and are comfortable communicating with insurance providers to identify and resolve coverage and billing issues.
If your background is primarily in medical billing or medical coding, this position may not be the right fit. We are specifically seeking candidates with direct third-party pharmacy rejection experience.
Required:
- 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.
Preferred:
- Previous pharmacy experience.
- Long-Term Care Pharmacy experience.
- Experience with New York pharmacy billing claims.
- Frameworks/ECM experience.
- Experience working directly with insurance providers to resolve pharmacy claim rejections.
Schedule
We are hiring for multiple shifts!
Candidates must have weekend availability. Flexibility to work evenings and/or overnight shifts is strongly preferred.
Available shifts may include:
- 8:00 AM - 4:00 PM
- 9:00 AM - 5:00 PM
- 11:00 AM - 7:00 PM
- 12:00 PM - 8:00 PM
- 3:00 PM - 11:00 PM
- 4:00 PM - 12:00 AM
What We Offer
- Competitive pay based on experience.
- Stable and consistent scheduling.
- Opportunities for career growth.
- Health, dental, and vision insurance.
- Group life insurance and short-term disability.
- Paid time off and paid holidays.
- 401(k) with company match.
- Paid training and development opportunities.
- Collaborative and supportive work environment.
Ready to Join the SpecialtyRx Team?
Apply today through our careers portal:
Apply Here - SpecialtyRx Careers
We look forward to reviewing your application and connecting with qualified candidates to schedule an interview.
EEO Statement
SpecialtyRx, Inc. is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation, gender identity, or any other status protected by federal, state, or local law.
EO/Minorities/Females/Disabled/Veterans