Reimbursement Specialist - Days - Remote

VCU Health • Richmond, VA

4d • $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 processes approvals or denials efficiently by phone, fax, or electronically. The specialist conducts benefit investigations and coordinates Patient Assistance Programs and/or copay cards for patients with high copays or no insurance coverage. The role 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 is helpful, or the specialist should be willing to research it. The specialist may also work as a Pharmacy Technician when needed. This position is remote for candidates in the Virginia area only.

Requirements

• Current Pharmacy Technician Certification Board (PTCB) certification.
• Current licensure with the Virginia State Board of Pharmacy.
• A clean criminal record: no felony convictions or drug- or pharmacy-related convictions, including misdemeanors; no denial, suspension, revocation, or restriction of registration or licensure by any State Board of Pharmacy.
• At least one year of previous pharmacy practice experience in a similar setting.
• At least three years of experience with manufacturers' Patient Assistance Programs and prior experience with prescription online adjudication.
• Previous experience using a personal computer, billing software applications, email, spreadsheets, word processing, and databases.
• High school diploma or equivalent.
• Able to work all shifts, weekends, holidays, and emergency coverage.
• Able to lift less than 20 pounds; perform prolonged standing and sitting, frequent bending, walking, climbing, reaching, and repetitive motion.
• Strong recall, reasoning, problem-solving, hearing, clear speech, legible writing, reading, and logical thinking.
• Able to work in fast- and steady-paced environments, manage multiple priorities, handle frequent and intense customer interactions, work in a noisy environment, and adapt to frequent change.

Nice To Haves

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

Responsibilities

• Initiate, follow up on, and process prior authorization requests and approvals or denials by phone, fax, or electronically.
• Conduct benefit investigations and coordinate Patient Assistance Programs and/or 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 necessary.
• Identify equipment problems and assist the pharmacist with tasks that do not require pharmacist supervision or checking.

What This Job Offers

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