Reimbursement Specialist - Days

VCU Health•Richmond, VA

5d•Onsite

About The Position

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.

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 of previous pharmacy practice experience in a similar setting
Minimum of three (3) years of 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

Nice To Haves

Familiarity with disease state terminology or willingness to research
Associate's Degree in Business or related field from an accredited program

Responsibilities

Initiate, follow-up, and proceed with approval and/or denials of prior authorizations efficiently via phone, fax, or electronically.
Carry out benefit investigation and coordinate Patient Assistance Programs and/or copay cards for patients with high co-pays or those without insurance coverage.
Work closely with nursing and physicians in order to obtain required documentation for prior authorization and billing.
Arrange refills, transfers, and delivery of medications.
Update patient case management system regularly.
Work as a Pharmacy Technician when deemed necessary.