Job Title:  Rejections   Technician

FLSA Status: Non-exempt

Reports to:  Lead Revenue Rejections Technician 

Hourly/Salary: Hourly

Department:  Data   Entry

Schedule : 3:00 p.m. to 11:00 p.m. or 4:00p.m. to 12:00 a.m. 

* must be available to work weekends and holidays on a rotating basis and/or as needed*

SUMMARY:

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.

ESSENTIAL FUNCTIONS: 

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Predictable, reliable, and punctual attendance is an essential function of the job role. The functions are as follow but not limited to: 

Key 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. 

 PHYSICAL DEMANDS:   

The physical demands and work environment described here are representative of those an employee encounters while performing the essential functions of this job. 

 The regular work schedule for this position is approximately 40 hours per week (Monday-Friday) and includes Saturdays/Sundays  plus holidays on a rotating basis, and may require additional hours/overtime as necessary .  

Sitting for extended periods of time, computer usage including data entry for much of the workday, regular phone communication, handling paperwork and documentation, and participating in meetings. Field position requiring frequent local travel throughout the state and occasional overnight stays.

 MINIMUM 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. 

· Computer Skills: Intermediate computer proficiency. Pharmacy and medication distribution software (EMAR, Pyxis Medbank, Frameworks preferred.· 

Language Skills: 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.· 

Mathematical Skills: 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.This job description is intended to convey information essential to understanding the scope of the Account Manager's position and it is not intended to be an exhaustive list of skills, efforts, duties, responsibilities, or working conditions associated with the role. 

 Required Skills & Competencies

• 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. 
• Pharmacy   Technician certification (CPhT) preferred or required per state regulations.