[Hiring] Reimbursement Specialist Supervisor @VCU Health

Role Description

The Reimbursement Specialist Supervisor oversees the daily operations of the Reimbursement Specialist team to ensure timely and accurate processing of prior authorizations, insurance follow-ups, and patient assistance program requests pertaining to high-cost medications that require prior authorization. This role provides guidance, coaching, and performance management for team members, while supporting workflow optimization and departmental revenue collection goals.

• Supervise, coordinate, and prioritize the workflow of Reimbursement Specialists across multiple clinics.
• Provide direct line supervision for Reimbursement Specialists, including:
  • Performance evaluations
  • Disciplinary action
  • Time/attendance
  • Coordination of staff activities
  • Conduct hiring, interviewing, onboarding, and training of new employees
• Monitor team productivity and compliance with turnaround times, providing feedback and coaching as needed.
• Facilitate training and onboarding of new Reimbursement Specialists.
• Review complex or escalated prior authorizations and appeals, ensuring appropriate documentation and compliance with insurance and regulatory requirements.
• Collaborate with providers, nursing staff, and the Patient Assistance Program (PAP) team to ensure patients receive timely access to medications.
• Identify process improvements to optimize team efficiency and patient care outcomes.
• Prepare and review reports on team performance, Patient Assistance (PA) approvals/denials, and workload metrics.
• Ensure compliance with departmental and health system policies and regulatory requirements.
• Participate in special projects and cross-functional initiatives as assigned.
• Serve as a point of contact for internal and external escalations related to PAs, appeals, or patient access concerns.
• Perform other duties as assigned and/or participate in special projects to support the mission of VCUHS and the Department.

Qualifications

• High School Diploma or equivalent (Required)
• Associate’s Degree or higher in Business, Healthcare Administration, or related field (Preferred)
• Current certification by the Pharmacy Technician Certification Board (PTCB) (Required)
• Current licensure with the Virginia State Board of Pharmacy (Required)
• Additional supervisory or leadership certifications (Preferred)
• Minimum of three (3) years of experience as a Reimbursement Specialist or equivalent role
• Previous experience supervising or mentoring staff
• Strong knowledge of PAPs, prior authorizations, and insurance benefit investigations
• Proficiency in EMR systems and Microsoft Office
• Cultural Responsiveness
• Strong leadership and communication skills (Preferred)
• Ability to handle multiple priorities and high-volume workload (Preferred)

Requirements

• Periods of high stress and fluctuating workloads may occur.
• General office environment.
• May be exposed to high noise levels and bright lights.
• May have periods of constant interruptions.
• Prolonged periods of working alone.
• Physical Demands: Lifting/Carrying (0-50 lbs.), Bending
• Work Position: Sitting, Walking, Standing
• Additional Physical Requirements:
  • Manual dexterity (eye/hand coordination)
  • Perform shift work
  • Hear alarms/telephone/tape recorder
  • Reach above shoulder
  • Repetitive arm/hand movements
  • Finger Dexterity
  • Color Vision
  • Acuity - far
  • Acuity - near
• Hazards:
  • Mental/Sensory – Emotional
  • Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking
  • Emotional: Fast-paced environment, Steady Pace, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent Change

Benefits

• Compensation Range: $25.03 - $38.79
• Actual salary offers will be based on several key factors to include relevant work experience, credentials, and qualifications.