Remedi SeniorCare

  • Reject Specialist

    Location US-OH-Dublin
    Job ID
    2018-2543
    Functional Area
    Billing
  • Overview

    The Reject Specialist is responsible for accurate and timely reject resolution.

    Responsibilities

    • Monitor and resolve rejected claims appearing on pharmacy system Dashboard for assigned pharmacy.
    • Become familiar with each pharmacy’s policies and procedures regarding claims management.
    • Knowledge of third party policies and NCPDP standard for claim submission.
    • Communicates with other departments on claim related matters.
    • Complies and enforces all company and departmental policies and procedures.
    • Complies with all applicable state and federal regulations related to pharmacy and claim billing practices.
    • Responsible with achieving department goals in volume, production, quality, customer service.
    • Direct claims to other departments for resolution as deemed necessary
    • Identify trending by recognizing problem areas for pharmacies that may reduce rejections when corrected.

    Qualifications

    • High school diploma or GED equivalent.  Proficient in Excel, Word and Outlook required, general knowledge and understanding of third party claim submission
    • Minimum of two years medical billing or third party claim submission desired.  Previous LTC pharmacy billing preferred.
    • Must be able to communicate effectively both verbally and in writing. Individual must have a strong internal and external customer service focus, and work as a team player.

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