[Hiring] Reimbursement Specialist @VCU Health

Role Description

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.

• 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 to obtain required documentation for prior authorization and billing.
• Arranges refills, transfers, and delivery of medications.
• Updates patient case management system regularly.
• Familiar with disease state terminology or willingness to research.
• Works as a Pharmacy Technician when deemed necessary.

Qualifications

• 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.

Requirements

• 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 online adjudication.
• Previous work experience using a personal computer and various billing software applications as well as e-mail, spreadsheets, word processing, databases, etc.

Education/training

• High School Diploma or equivalent.
• Associate's Degree in Business or related field from an accredited program (preferred).

Additional position requirements

• Able to work all shifts, weekends, holidays, emergency coverage.

Physical Requirements

• 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.