Reimbursement Specialist - Days

VCU Health • Richmond, VA

3d • $20 - $31 • Remote

About The Position

The Reimbursement Specialist improves revenue collection for high-cost medications requiring prior authorization. The role initiates and follows up on prior authorizations and proceeds with approvals or denials via phone, fax, or electronic methods. It conducts benefit investigations and coordinates Patient Assistance Programs and copay cards for patients with high copays or no insurance coverage. The specialist works closely with nursing staff and physicians to obtain documentation needed for prior authorization and billing, arranges medication refills, transfers, and delivery, and regularly updates the patient case management system. Familiarity with disease-state terminology, or willingness to research it, is desirable. The role may also work as a Pharmacy Technician when deemed necessary.

This remote position is limited to candidates in Virginia and requires both current Pharmacy Technician Certification Board (PTCB) certification and Virginia State Board of Pharmacy licensure. Candidates must have a clean criminal record as specified in the posting, with no felony conviction or drug- or pharmacy-related convictions, including misdemeanors, and no denial, suspension, revocation, or restriction of pharmacy registration or licensure. Those credentials must be maintained during employment.

The role requires at least one year of pharmacy practice experience in a similar setting and at least three years of experience with manufacturers’ Patient Assistance Programs and prescription online adjudication. Prior experience using a personal computer and billing software, email, spreadsheets, word processing, and databases is also required. A high school diploma or equivalent is required; an associate’s degree in business or a related field is preferred. Compensation is listed at $19.87–$30.79, with actual offers based on relevant work experience, credentials, and qualifications.

Requirements

• Current Pharmacy Technician Certification Board (PTCB) certification.
• Current licensure with the Virginia State Board of Pharmacy.
• At least one year of pharmacy practice experience in a similar setting.
• At least three years of experience with manufacturers’ Patient Assistance Programs and prescription online adjudication.
• Experience using a personal computer and billing software applications, as well as email, spreadsheets, word processing, and databases.
• High school diploma or equivalent.
• Clean criminal record as specified: no felony conviction; no drug- or pharmacy-related convictions, including misdemeanors; and no denial, suspension, revocation, or restriction of registration or licensure by any State Board of Pharmacy.
• Ability to work all shifts, weekends, holidays, and emergency coverage.

Nice To Haves

• Familiarity with disease-state terminology, or willingness to research it.
• Associate’s degree in business or a related field from an accredited program.

Responsibilities

• Initiate and follow up on prior authorizations for high-cost medications, pursuing approvals or denials by phone, fax, or electronically.
• Conduct benefit investigations and coordinate Patient Assistance Programs and copay cards for patients with high copays or no insurance coverage.
• Work with nursing staff and physicians to obtain documentation required for prior authorization and billing.
• Arrange medication refills, transfers, and delivery.
• Regularly update the patient case management system.
• Work as a Pharmacy Technician when deemed necessary.
• Identify equipment problems and perform aspects of assisting the pharmacist that do not require pharmacist supervision or a check.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED