Pharmaceutical Rejections Technician - Data Entry

MedWiz Mgmt LLC•Bardonia, NY

7d•Onsite

About The Position

The Rejections Technician is responsible for reviewing, researching, and resolving rejected pharmacy claims to ensure timely and accurate billing within a Long-Term Care (LTC) pharmacy environment. This role serves as a key liaison between insurance providers, pharmacy staff, and long-term care facilities to resolve claim issues that impact medication access and reimbursement. The ideal candidate demonstrates strong critical thinking skills, attention to detail, and the ability to independently analyze claim rejections, identify root causes, and implement appropriate solutions while maintaining compliance with pharmacy regulations and payer requirements.

Requirements

High school diploma or equivalent required.
Pharmacy Technician experience preferred; LTC pharmacy experience strongly preferred.
Previous experience with pharmacy billing, insurance claims, or healthcare revenue cycle preferred.
Knowledge of Medicare Part D, Medicaid, and third-party billing is a plus.
Pharmacy Technician certification (CPhT) preferred or required per state regulations.
Intermediate computer proficiency.
Ability to read and interpret documents such as medication documentation, business correspondence and procedure manuals.
Ability to write routine reports and business correspondence.
Ability to speak effectively, both in person and by telephone, to customers or employees of the organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to understand and interpret statistical reports, data charts and graphs.
Strong critical thinking and problem-solving abilities.
Ability to interpret insurance rejection messages and billing edits.
Excellent verbal and written communication skills.
High attention to detail and accuracy.
Ability to prioritize workload in a fast-paced environment.
Strong organizational and time management skills.
Ability to work independently while collaborating with cross-functional teams.
Professional phone etiquette when interacting with insurance representatives and facility staff.
Basic computer proficiency and ability to learn pharmacy billing systems.

Nice To Haves

Pharmacy and medication distribution software (EMAR, Pyxis Medbank, Frameworks preferred).

Responsibilities

Review and work assigned queues of rejected pharmacy claims in a timely manner.
Analyze claim rejections to determine root cause and appropriate resolution steps.
Contact insurance companies, Pharmacy Benefit Managers (PBMs), and plan representatives to obtain claim clarification, overrides, or billing guidance.
Communicate with long term care facilities to obtain required documentation, insurance updates, or prescription clarification needed for claim resolution.
Apply appropriate override codes and ensure accurate documentation of all actions taken.
Research eligibility, coordination of benefits, prior authorization requirements, and formulary restrictions.
Ensure claims are billed correctly according to payer guidelines, Medicare Part D, Medicaid, Managed Care, and commercial insurance requirements.
Document all research, communications, and claim actions clearly and accurately in the pharmacy system.
Escalate complex or unresolved issues to supervisors or billing leadership when appropriate.
Maintain productivity and quality standards while meeting turnaround expectations.
Support continuity of patient care by resolving billing issues that may delay medication access.
Stay current on payer policies, billing regulations, and LTC pharmacy procedures.