Job Description

Work Schedule:

U.S. business hours | Full-time or Part-time

Role Overview:

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

Key Responsibilities:

Review rejected insurance claims via the pharmacys billing or POS system



Identify rejection codes and determine the root cause (e.g., prior authorisation, plan limit, incorrect info)



Communicate with prescriber offices to request missing documentation or initiate prior authorisation



Follow up with patients to clarify insurance information or notify them of rejection status



Track all rejection cases and resolution outcomes using internal logs or pharmacy CRM



Escalate unresolved or recurring issues to the supervising pharmacist or billing manager



Maintain HIPAA-compliant documentation and protect all patient information



Support billing, claim resubmission, and reporting tasks as assigned

Qualifications:

Proven experience in pharmacy billing, claims processing, or healthcare support



Strong understanding of U.S. pharmacy claim workflows and PBM portals



Familiarity with rejection codes and insurance-related terminology



Excellent English communication skills (verbal and written)



Detail-oriented with strong organisational and documentation skills



HIPAA certification or willingness to complete one upon hire



Knowledge of systems like PioneerRx, QS/1, or similar pharmacy software is a plus