Reimbursement Specialist - Ambulatory - Days - Remote

VCU Health • Richmond, VA

4d • 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. By 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 Who We Are Inventing better care, day by day by discovery Sound outrageous? It absolutely is. Sound impossible? That’s never stopped us before. Sound like hard work, intense research, collaboration with experts around the world, sheer brainpower meets unrelenting willpower? That’s. Exactly. Right. We’ll do whatever it takes to offer the best in care and empower the best in quality of life. And it’s an approach that works — whether it’s a patient who undergoes a new, life-saving procedure or a clinical researcher who finds promise in a new cancer treatment, exciting new medicine is happening at VCU Health. We have it all: • One college and four health sciences schools • An academic medical center • A Level I trauma center • One of only two NCI-designated cancer centers in Virginia • The region’s only full-service children’s hospital • More than 800 physicians in 200 specialties • With a community health center, dedicated research teams, facilities and valued partners in every field Our medical teams are top notch. And we’re not too shy to boast of internationally known physicians, some recognized as the best in the country, top-ranked local specialists and all-around all-stars at every level. From our very first years to our most recent advancements, we are driven to learn more, dig deeper, teach passionately and never rest in order to be a true leader in discovering what’s possible in health and recovery. We are a comprehensive system of care and a pioneer of health. Read VCU Health Year In Review for more about our accomplishments.

Requirements

• Current certification by the Pharmacy Technician Certification Board (PTCB)
• Current licensure with the Virginia 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
• Physical: Lifting less than 20 lbs.
• Activities: Prolonged standing, Prolonged sitting, Frequent bending, Walking (distance), Climbing (steps, ladder, other), Reaching (overhead, extensive, repetitive), Repetitive motion
• Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking
• Emotional: Fast pace environment, Steady pace, Able to handle multiple priorities, Frequent and intense customer interactions, Noisy environment, Able to adapt to frequent change

Nice To Haves

• Associates Degree in Business or related field from an accredited program
• Ideally, this role is familiar with disease state terminology or willingness to research.

Responsibilities

• Initiate, follow-up, and proceed 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