Reimbursement Specialist - Ambulatory - Days

VCU Health • Richmond, VA

3d • Remote

About The Position

Remote: To the Virginia area only. The Reimbursement Specialist improves revenue collection pertaining to high cost medications that require prior authorization. This job will initiate, follow-up, and proceed with approval and/or denials of prior authorizations efficiently via phone, fax, or electronically. The Reimbursement Specialist carries out benefit investigation and coordinates Patient Assistance Programs and/or copay cards for patients with high co-pays or those without insurance coverage. This role works closely with nursing and physicians in order to obtain required documentation for prior authorization and billing. The Reimbursement Specialist arranges refills, transfers, and delivery of medications. Updates patient case management system regularly. Ideally, this role is familiar with disease state terminology or willingness to research. This role also works as a Pharmacy Technician when deemed necessary. Licensure, Certification, or Registration Requirements for Hire:Current certification by the Pharmacy Technician Certification Board (PTCB) Current licensure with the Virginia State Board of PharmacyBy virtue of societal trust and security explicitly imparted to pharmacies for the control of drugs, candidate/incumbent must have a clean criminal record (i.e. no felony conviction; no drug or pharmacy related convictions, including misdemeanors); no denial, suspension, revocation, or restriction of registration or licensure by any State Board of Pharmacy Licensure, Certification, or Registration Requirements for continued employment:Current certification by the Pharmacy Technician Certification Board (PTCB) Current licensure with the Virginia State Board of Pharmacy

Requirements

• Current certification by the Pharmacy Technician Certification Board (PTCB)
• Current licensure with the Virginia State Board of Pharmacy
• Clean criminal record (i.e. no felony conviction; no drug or pharmacy related convictions, including misdemeanors); no denial, suspension, revocation, or restriction of registration or licensure by any State Board of Pharmacy
• Minimum of one (1) year previous pharmacy practice experience in a similar setting
• Minimum of three (3) years prior experience with Manufacturers Patient Assistance Programs and prior experience with prescription on-line adjudication
• Previous work experience using a personal computer and various billing software applications as well as e-mail, spreadsheets, word processing, databases, etc.
• High School Diploma or equivalent
• Able to work all shifts, weekends, holidays, emergency coverage

Nice To Haves

• Associates Degree in Business or related field from an accredited program
• Familiar with disease state terminology or willingness to research.

Responsibilities

• Improves revenue collection pertaining to high cost medications that require prior authorization.
• Initiates, follows-up, and proceeds with approval and/or denials of prior authorizations efficiently via phone, fax, or electronically.
• Carries out benefit investigation and coordinates Patient Assistance Programs and/or copay cards for patients with high co-pays or those without insurance coverage.
• Works closely with nursing and physicians in order to obtain required documentation for prior authorization and billing.
• Arranges refills, transfers, and delivery of medications.
• Updates patient case management system regularly.
• Works as a Pharmacy Technician when deemed necessary.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees